Journal articles: 'Oropharyngeal airway'

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Chen, Ying-Sheng, Szu-Ting Chou, Jung-Hsuan Cheng, Shis-Chieh Chen, Chin-Yun Pan, and Yu-Chuan Tseng. "Importance in the Occurrence Distribution of Minimum Oropharyngeal Cross-Sectional Area in the Different Skeletal Patterns Using Cone-Beam Computed Tomography." BioMed Research International 2021 (May 5, 2021): 1–8. http://dx.doi.org/10.1155/2021/5585629.

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Purpose. Obstructive sleep apnea is a condition involving repetitive partial or complete collapse of the pharyngeal airway, especially in patient with mandibular hypoplasia. The present study investigated the differences between the volume of the oropharyngeal airway and the minimum axial area in three skeletal patterns through the use of cone-beam computed tomography (CBCT). Materials and Methods. CBCT scans of 147 patients were collected to measure the upper oropharyngeal airway volume (UOV), lower oropharyngeal airway volume (LOV), upper oropharyngeal airway area (UOA), minimum upper oropharyngeal airway area (MUOA), lower oropharyngeal airway area (LOA), minimum lower oropharyngeal airway area (MLOA), anatomical structures (orbitale, Or; porion, Po; pogonion, Pog; hyoid, H; second cervical vertebra, C2; fourth cervical vertebra, C4), and relevant angles. Statistical analysis was performed using analysis of variance and Pearson’s test. Results. Compared with patients in Class II, those in Class III and Class I exhibited a significantly anterior position of H and Pog. The vertical positions of H and Pog revealed no significant difference between the three skeletal patterns. Patients in skeletal Class III exhibited significantly larger oropharyngeal area (UOA, MUOA, LOA, MLOA) and oropharyngeal airway (UOV and LOV) than those in skeletal Class II did. The horizontal position of Pog had a moderately significant correlation with UOA ( r = 0.471 ) and MUOA ( r = 0.455 ). Conclusion. Patients in skeletal Class II had significantly smaller oropharyngeal airway areas and volumes than those in Class III did. The minimum oropharyngeal cross-sectional area had a 67% probability of occurrence in the upper oropharyngeal airway among patients in Class I and Class II and a 50% probability of occurrence among patients in Class III.

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Dravid, R. M., and M. T. Popat. "The cuffed oropharyngeal airway." Anaesthesia 54, no. 4 (April 1999): 402. http://dx.doi.org/10.1046/j.1365-2044.1999.00873.x.

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Mehta, S. "A supraglottic oropharyngeal airway." Anaesthesia 45, no. 10 (October 1990): 893–94. http://dx.doi.org/10.1111/j.1365-2044.1990.tb14602.x.

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Joshi, P., R. Ooi, and S. A. Feldman. "The supraglottic oropharyngeal airway." Anaesthesia 46, no. 2 (February 1991): 151. http://dx.doi.org/10.1111/j.1365-2044.1991.tb09372.x.

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Takaishi, Kazumi, Shinji Kawahito, Shigemasa Tomioka, Satoru Eguchi, and Hiroshi Kitahata. "Cuffed Oropharyngeal Airway for Difficult Airway Management." Anesthesia Progress 61, no. 3 (September 1, 2014): 107–10. http://dx.doi.org/10.2344/0003-3006-61.3.107.

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Abstract Difficulties with airway management are often caused by anatomic abnormalities due to previous oral surgery. We performed general anesthesia for a patient who had undergone several operations such as hemisection of the mandible and reconstructive surgery with a deltopectoralis flap, resulting in severe maxillofacial deformation. This made it impossible to ventilate with a face mask and to intubate in the normal way. An attempt at oral awake intubation using fiberoptic bronchoscopy was unsuccessful because of severe anatomical abnormality of the neck. We therefore decided to perform retrograde intubation and selected the cuffed oropharyngeal airway (COPA) for airway management. We inserted the COPA, not through the patient's mouth but through the abnormal oropharyngeal space. Retrograde nasal intubation was accomplished with controlled ventilation through the COPA, which proved to be very useful for this difficult airway management during tracheal intubation even though the method was unusual.

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van Vlymen, Janet M., Wen Fu, Paul F. White, Kevin W. Klein, and James D. Griffin. "Use of the Cuffed Oropharyngeal Airway as an Alternative to the Laryngeal Mask Airway with Positive-pressure Ventilation." Anesthesiology 90, no. 5 (May 1, 1999): 1306–10. http://dx.doi.org/10.1097/00000542-199905000-00014.

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Background The cuffed oropharyngeal airway is a modified Guedel-type oral airway with a cuff at its distal end. The objectives of this study were to compare the ability of the cuffed oropharyngeal airway and the laryngeal mask airway to provide positive-pressure ventilation during general anesthesia, and to assess their relative ease of use and ability to reduce total fresh gas flow rates. Methods In this prospective, randomized study, a cuffed oropharyngeal airway (n = 25) or a laryngeal mask airway (n = 25) device was inserted after induction of anesthesia intravenously using 2 mg/kg propofol. While anesthesia was maintained with sevoflurane and nitrous oxide, the leak pressure, leak fraction (the fractional difference between the inspired and expired tidal volume), minimum fresh gas flow rate, and need for airway manipulations were determined. The anesthesia provider who inserted the device completed an evaluation form at the end of the 15-min study period. Results Positive-pressure ventilation was established successfully on the first attempt in 92% of the patients when the cuffed oropharyngeal airway was used and in 88% of the patients when the laryngeal mask airway device was used. However, manipulations of the airway device were necessary more frequently (8 vs. 1 patient; P < 0.05) and the leak pressure was less (22 +/- 6 cm water vs. 26 +/- 5 cm water; P < 0.05) with the cuffed oropharyngeal airway than with the laryngeal mask airway. In addition, the leak fraction (0.19 +/- 0.18 vs. 0.31 +/- 0.22; P < 0.05) and the minimum fresh gas flow rate (1.3 +/- 1.5 vs. 2.4 +/- 2.5; P = 0.12) were less in the laryngeal mask airway group. Conclusions Positive-pressure ventilation is possible with the laryngeal mask airway and cuffed oropharyngeal airway devices. Although the cuffed oropharyngeal airway can be inserted easily by inexperienced users with a high first-attempt success rate (> 90%), manipulations of the device may be required to maintain a patent airway. The laryngeal mask airway device allows positive-pressure ventilation at slightly greater peak inspiratory pressures.

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Rosenberg, M. B., J. C. Phero, and D. E. Becker. "Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways." Anesthesia Progress 61, no. 3 (September 1, 2014): 113–18. http://dx.doi.org/10.2344/0003-3006-61.3.113.

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Abstract Offices and outpatient dental facilities must be properly equipped with devices for airway management, oxygenation, and ventilation. Part 1 in this series on emergency airway management focused on basic and fundamental considerations for supplying supplemental oxygen to the spontaneously breathing patient and utilizing a bag-valve-mask system including nasopharyngeal and oropharyngeal airways to deliver oxygen under positive pressure to the apneic patient. This article will review the evolution and use of advanced airway devices, specifically supraglottic airways, with the emphasis on the laryngeal mask airway, as the next intervention in difficult airway and ventilation management. The final part of the series (part 3) will address airway evaluation, equipment and devices for tracheal intubation, and invasive airway procedures.

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Rizk, Susan, Valmy Pangrazio Kulbersh, and Riyad Al-Qawasmi. "Changes in the oropharyngeal airway of Class II patients treated with the mandibular anterior repositioning appliance." Angle Orthodontist 86, no. 6 (December 9, 2015): 955–61. http://dx.doi.org/10.2319/042915-295.1.

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ABSTRACT Objective: To evaluate the effects of functional appliance treatment on the oropharyngeal airway volume, airway dimensions, and anteroposterior hyoid bone position of growing Class II patients. Materials and Methods: Twenty Class II white patients (mean age, 11.7 ± 1.75 years) treated with the MARA followed by fixed appliances were matched to an untreated control sample by cervical vertebrae maturation stage at pretreatment (T1) and posttreatment (T2) time points. Cone beam computed tomography scans were taken at T1 and T2. Dolphin3D imaging software was used to determine oropharyngeal airway volume, dimensions, and anteroposterior hyoid bone position. Results: Multivariate ANOVA was used to evaluate changes between T1 and T2. Oropharyngeal airway volume, airway dimensions, and A-P position of the hyoid bone increased significantly with functional appliance treatment. SNA and ANB decreased significantly in the experimental group (P ≤ .05). Changes in SNB and Sn-GoGn failed to reach statistical significance. Conclusions: Functional appliance therapy increases oropharyngeal airway volume, airway dimensions, and anteroposterior hyoid bone position in growing patients.

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McConnell, Edwina A. "INSERTING AN OROPHARYNGEAL AIRWAY PROPERLY." Nursing 24, no. 12 (December 1994): 20–23. http://dx.doi.org/10.1097/00152193-199412000-00008.

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Shimoyama, T., T. Kato, Norio Horie, D. Nasu, and T. Kaneko. "Oropharyngeal airway appliance for infant with upper airway obstruction: report of a case." Journal of Clinical Pediatric Dentistry 27, no. 1 (September 1, 2003): 25–28. http://dx.doi.org/10.17796/jcpd.27.1.69h1nxnt137p060q.

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A palatal appliance with oropharyngeal tube that reduces the upper airway obstructions of an elevenmonth-old male infant with severe cerebral palsy is presented. The palatal appliance was composed of the base plate, the outer guide tube that held the oropharyngeal tube inside it, and the extra outer guide tube for the suction catheter. After the setting of the appliance, respiratory distress was improved without side effects.

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Yahagi, N., M. Kono, M. Kitahara, K. Watanabe, Y. Fujiwara, Y. Asakawa, J. Katagiri, M. Sha, and A. Ohmura. "Causes of airway obstruction during cuffed oropharyngeal airway use." Resuscitation 48, no. 3 (March 2001): 275–78. http://dx.doi.org/10.1016/s0300-9572(00)00258-6.

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Sampson, Michael. "A current guide to airway management in prehospital patient care." Journal of Paramedic Practice 13, no. 4 (April 2, 2021): 1–10. http://dx.doi.org/10.12968/jpar.2021.13.4.cpd1.

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A patent airway linking the nose and mouth with the lungs is essential to life. In emergency care, individuals may experience airway difficulties for many reasons including major trauma, airway inflammation and altered consciousness. Airway management is therefore a core skill for paramedics and other practitioners working in prehospital care. This article reviews the anatomy and physiology of the airway before moving on to consider causes of airway obstruction. A look-listen-feel approach to airway assessment is described, followed by a discussion of techniques used to clear, open and maintain the airway. Commonly used airway devices including oropharyngeal, nasopharyngeal and supraglottic airways are evaluated, and their indications and insertion techniques discussed. The use of endotracheal intubation by paramedics is also evaluated.

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Rimmer, J., A. Singh, C. Irving, D. J. Archer, and P. Rhys Evans. "Asymptomatic oropharyngeal lipoma complicating intubation." Journal of Laryngology & Otology 119, no. 6 (June 2005): 483–85. http://dx.doi.org/10.1258/0022215054273106.

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Oropharyngeal lipomas are rare tumours. We present the case of a young man with an asymptomatic lipoma almost completely occluding his supraglottic airway, found on magnetic resonance imaging (MRI) for a separate oral cavity lesion. Pre-operative anaesthetic assessment was undertaken because of the risk of airway obstruction at induction of general anaesthesia. We discuss the awake fibre-optic technique used for induction, as well as the treatment and follow-up of these tumours. This case highlights the need for formal anaesthetic assessment, in such cases, to avoid total airway obstruction at induction of general anaesthesia. It also emphasizes the extent of supraglottic obstruction that can be present without giving rise to any symptoms.

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Sampson, Michael. "A guide to airway management." British Journal of Cardiac Nursing 16, no. 3 (March 2, 2021): 1–13. http://dx.doi.org/10.12968/bjca.2020.0093.

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A patent airway linking the nose and mouth with the lungs is essential to life. Critically ill people often experience airway difficulties for reasons including alterations in consciousness, the use of sedating medications, and inflammatory changes within the airway. Airway management is therefore a core skill for any clinician caring for critically ill people. This article briefly reviews the anatomy and physiology of the airway before moving on to consider causes of airway obstruction. A look-listen-feel approach to airway assessment is described, followed by a discussion of techniques used to clear, open and maintain the airway. Commonly used airway devices including oropharyngeal, nasopharyngeal and supraglottic airways are evaluated, and their indications and insertion techniques discussed. The role of the endotracheal tube in the critically ill person is also considered.

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Baskett, Thomas F. "Arthur Guedel and the oropharyngeal airway." Resuscitation 63, no. 1 (October 2004): 3–5. http://dx.doi.org/10.1016/j.resuscitation.2004.07.004.

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Asai, T. "The cuffed oropharyngeal airway: a reply." Anaesthesia 54, no. 4 (April 1999): 402–3. http://dx.doi.org/10.1046/j.1365-2044.1999.0873a.x.

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Loke, G. P. Y., S. M. Tan, and A. S. B. Ng. "Appropriate Size of Laryngeal Mask Airway for Children." Anaesthesia and Intensive Care 30, no. 6 (December 2002): 771–74. http://dx.doi.org/10.1177/0310057x0203000609.

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The aim of this crossover study was to determine the optimal size of laryngeal mask airway in children weighing 10 to 20 kg. In each of 67 apnoeic anaesthetized children, the size 2 and size 2½ laryngeal mask airways were inserted consecutively by a skilled user and the cuff inflated to 60 cmH 2 O. Each LMA was assessed for the ease of insertion (by the number of attempts), oropharyngeal leak pressure, anatomical position (assessed fibreoptically) and the volume of air required to achieve intracuff pressure of 60 cmH 2 O. During the measurement of oropharyngeal leak pressure, the airway pressure was not allowed to exceed 30 cmH 2 O. There was no failed attempt at insertion with any size. The oropharyngeal leak pressure was significantly less for the size 2 LMA compared to the size 2½ LMA (P<0.001). The oesophagus was visible on three occasions, all with the size 2 LMA. Gastric insufflation occurred in three patients, all with the size 2 LMA. The incidence of low oropharyngeal leak pressure (<10 cmH 2 O) was low (9.0%) and all occurred with the size 2 LMA. The fibreoptic bronchoscope scores were not significantly different between the two sizes of LMAs. The volume of air to achieve intracuff pressure of 60 cmH 2 O was much lower than the maximum recommended volume (5.1 ml for size 2 and 6.2 ml for size 2½ ). We conclude that the size 2½ LMA provides a better fit than size 2 in children 10 to 20 kg.

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Williams, R. Tudor. "Intubation with an “Airway Intubator”." Prehospital and Disaster Medicine 1, S1 (1985): 210–11. http://dx.doi.org/10.1017/s1049023x00044496.

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Airway Intubators are obtainable from Williams Airway Intubator Limited, 405–206 7th Avenue S.W., Calgary T2P0W7 CanadaThe Airway Intubator serves two purposes: as an oropharyngeal airway and, should the need arise, an endotracheal tube can be passed through the center of the airway intubator into the trachea without the need for further instrumentation.Sykes, in 1937, described a divided airway made of aluminum; following the introduction of the endotracheal tube, both halves of the airway were removed leaving the endotracheal tube in place. A plastic airway, as designed in the 1970's by Berman, consisted of a tunnel along its whole length so that an endotracheal tube was compelled to follow this pathway.With the advent of plastic endotracheal tubes with a relatively fixed radius of curvature, the airway intubator has been more successful than its predecessors, both as an oropharyngeal airway and as a means of intubating the trachea.

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Behringer, Elizabeth C. "Comparison of the Laryngeal Mask Airway and Cuffed Oropharyngeal Airway." Anesthesia & Analgesia 88, no. 4 (April 1999): 961. http://dx.doi.org/10.1213/00000539-199904000-00052.

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Brimacombe, J. R., J. C. Brimacombe, and A. M. Berry. "Comparison of the Laryngeal Mask Airway and Cuffed Oropharyngeal Airway." Anesthesia & Analgesia 88, no. 4 (April 1999): 961–62. http://dx.doi.org/10.1213/00000539-199904000-00053.

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Patel, Anil, and Adrian Pearce. "The Cuffed Oropharyngeal Airway and Management of the Difficult Airway." Anesthesiology 90, no. 3 (March 1, 1999): 924–25. http://dx.doi.org/10.1097/00000542-199903000-00047.

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Uezono, Shoichi, Takahisa Goto, and Shigeho Morita. "The Cuffed Oropharyngeal Airway and Management of the Difficult Airway." Anesthesiology 90, no. 3 (March 1, 1999): 925. http://dx.doi.org/10.1097/00000542-199903000-00048.

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Behringer, Elizabeth C. "Comparison of the Laryngeal Mask Airway and Cuffed Oropharyngeal Airway." Anesthesia & Analgesia 88, no. 4 (April 1999): 961. http://dx.doi.org/10.1097/00000539-199904000-00052.

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Brimacombe, J. R., J. C. Brimacombe, and A. M. Berry. "Comparison of the Laryngeal Mask Airway and Cuffed Oropharyngeal Airway." Anesthesia & Analgesia 88, no. 4 (April 1999): 961–62. http://dx.doi.org/10.1097/00000539-199904000-00053.

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Shanmugavelu, G., and T. Kanagarajan. "Comparing the functional analysis of I-gel with Baska mask in laparascopic surgeries: an observational study." International Journal of Research in Medical Sciences 6, no. 4 (March 28, 2018): 1440. http://dx.doi.org/10.18203/2320-6012.ijrms20181311.

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Background: More than 40% of general anaesthetics are managed with supraglottic airway devices. First generation SADs act as airway conduits whereas second generation devices have safety designs like integrated bite block, gastric drainage channel and act as airway conduit for endotracheal intubation. Supraglottic airway devices are getting accepted by many anaesthetists during laparascopic surgeries.Methods: Authors did a study, comparing the functional analysis of I- gel with Baska mask during laparascopic surgeries with controlled ventilation. The study was conducted on sixty patients of either sex scheduled for short duration laparascopic surgeries (<2 hs). The study conducted on ASA I and II patients with a BMI of <30kg/m2. Patients with restricted mouth opening(<2.5cm), difficult airway, known GERD patients, obese patients (>30kg/m2), and ASA physical status III and IV patients were excluded from the study. patients were induced with fentanyl 2µg/ kg, propofol 2-2.5mg/kg and neuromuscular paralysis facilitated with atracurium 0.5mg/kg. Anaesthesia was maintained with oxygen, air (fio2 40%) with isoflurane1.5-2%. Ease of insertion was evaluated using 4-points scale. Score 1 means easy insertion to score 4 denotes impossible to insert. Oropharyngeal seal pressure was measured after five minutes of placement. FGF 5L/min was used after closing the APL valve at 70cm h2o, recording the pressure at which pressue is plateaued. Presence of sore throat, dysphagia and dysphonia were examined 2hrs and 24hrs post operatively.Results: The insertion time was shorter for I-gel (12.3±3.8secs) than Baska mask (20.1±8.1secs). Oropharyngeal leak pressure was significantly higher for Baska mask (24-32cmh20). Oropharyngeal airway morbidity was not significantly different between two groups. So, it has been decided that both airways are suitable for laparascopic surgeries, but I-gel was quicker to insert, but Baska mask gave good airway seal.Conclusions: In this study, authors have noticed that Baska mask will give good airway seal when compared with I-gel. But I-gel was quicker to insert than Baskamask. The main problem of the study was that it was not blinded.

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Diwakar, Rohan, Anuraj Singh Kochhar, Harshita Gupta, Harneet Kaur, Maninder Singh Sidhu, Helen Skountrianos, Gurkeerat Singh, and Michele Tepedino. "Effect of Craniofacial Morphology on Pharyngeal Airway Volume Measured Using Cone-Beam Computed Tomography (CBCT)—A Retrospective Pilot Study." International Journal of Environmental Research and Public Health 18, no. 9 (May 10, 2021): 5040. http://dx.doi.org/10.3390/ijerph18095040.

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Background: The present study aimed to determine the correlation between pharyngeal airway volume and craniofacial morphology through cone-beam computed tomography (CBCT). Additionally, the study analyzed the influence of gender on pharyngeal airway volume. (2) Methods: 80 CBCT scans of 40 male and 40 female patients (mean age: 15.38 + 1.10 years) fulfilling the eligibility criteria were included. CBCT scans were evaluated for pharyngeal airway volume using the In Vivo Dental 5.1 software. Additionally, CBCT-derived lateral cephalograms were used to assess various craniofacial morphology parameters. To examine the influences of gender on airway volume, T-test was carried out. Correlation between airway volume and craniofacial parameters were measured using Pearson correlation followed by regression analysis. The value of p < 0.05 was considered statistically significant. Results: The mean airway volume was significantly greater in males than in females. A statistically significant negative correlation was found between maxillary plane inclination and pharyngeal airway volume. In contrast, a positive correlation was observed between mandibular length and lower molar inclination with oropharyngeal and total pharyngeal airway volume. Females showed a statistically significant positive correlation between the pharyngeal airway volume and sagittal position of maxilla and mandible; they also showed a negative correlation between oropharyngeal airway volume and the mandibular plane angle. Conclusions: Overall, the pharyngeal airway space differs significantly between males and females. Craniofacial morphology does have a significant effect on the pharyngeal airway, especially on the oropharyngeal airway volume.

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Chau, Jun Ting, Karen Peebles, Yvonne Belessis, Adam Jaffe, and Michael Doumit. "Distress during airway sampling in children with cystic fibrosis." Archives of Disease in Childhood 104, no. 8 (May 25, 2018): 806–8. http://dx.doi.org/10.1136/archdischild-2017-314241.

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BackgroundOropharyngeal suction and oropharyngeal swab are two methods of obtaining airway samples with similar diagnostic accuracy in children with cystic fibrosis (CF). The primary aim was comparing distress between suctioning and swabbing. A secondary aim was establishing the reliability of the Groningen Distress Rating Scale (GDRS).MethodsRandomised oropharyngeal suction or swab occurred over two visits. Two physiotherapists and the child’s parent rated distress using the GDRS. Heart rate (HR) was also measured.Results24 children with CF, mean age of 3 years, participated. Both physiotherapist and parent rating showed significantly higher distress levels during suction than swab. Inter-rater reliability for the GDRS was very good between physiotherapists, and good between physiotherapist and parents.ConclusionThe study found that oropharyngeal swab is less distressing in obtaining samples than oropharyngeal suction and that the GDRS was reliable and valid.

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Keller, Christian, Joseph Brimacombe, Marzia Giampalmo, Axel Kleinsasser, Alex Loeckinger, Giuseppe Giampalmo, and Fritz Pühringer. "Airway Management during Spaceflight." Anesthesiology 92, no. 5 (May 1, 2000): 1237–41. http://dx.doi.org/10.1097/00000542-200005000-00010.

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Background The authors compared airway management in normogravity and simulated microgravity with and without restraints for laryngoscope-guided tracheal intubation, the cuffed oropharyngeal airway, the standard laryngeal mask airway, and the intubating laryngeal mask airway. Methods Four trained anesthesiologist-divers participated in the study. Simulated microgravity during spaceflight was obtained using a submerged, full-scale model of the International Space Station Life Support Module and neutrally buoyant equipment and personnel. Customized, full-torso manikins were used for performing airway management. Each anesthesiologist-diver attempted airway management on 10 occasions with each device in three experimental conditions: (1) with the manikin at the poolside (poolside); (2) with the submerged manikin floating free (free-floating); and (3) with the submerged manikin fixed to the floor using a restraint (restrained). Airway management failure was defined as failed insertion after three attempts or inadequate device placement after insertion. Results For the laryngoscope-guided tracheal intubation, airway management failure occurred more frequently in the free-floating (85%) condition than the restrained (8%) and poolside (0%) conditions (both, P < 0.001). Airway management failure was similar among conditions for the cuffed oropharyngeal airway (poolside, 10%; free-floating, 15%; restrained, 15%), laryngeal mask airway (poolside, 0%; free-floating, 3%; restrained, 0%), and intubating laryngeal mask airway (poolside, 5%; free-floating, 5%; restrained, 10%). Airway management failure for the laryngoscope-guided tracheal intubation was usually caused by failed insertion (> 90%), and for the cuffed oropharyngeal airway, laryngeal mask airway, and intubating laryngeal mask airway, it was always a result of inadequate placement. Conclusion The emphasis placed on the use of restraints for conventional tracheal intubation in microgravity is appropriate. Extratracheal airway devices may be useful when restraints cannot be applied or intubation is difficult.

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Iwasaki, Tomonori, Hideo Sato, Hokuto Suga, Ayaka Minami, Yuushi Yamamoto, Yoshihiko Takemoto, Emi Inada, et al. "Herbst appliance effects on pharyngeal airway ventilation evaluated using computational fluid dynamics." Angle Orthodontist 87, no. 3 (January 25, 2017): 397–403. http://dx.doi.org/10.2319/080616-603.1.

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ABSTRACT Objective: To evaluate the effect of a Herbst appliance on ventilation of the pharyngeal airway (PA) using computational fluid dynamics (CFD). Materials and Methods: Twenty-one Class II patients (10 boys; mean age, 11.7 years) who required Herbst therapy with edgewise treatment underwent cone-beam computed tomography (CBCT) before and after treatment. Nineteen Class I control patients (8 boys; mean age, 11.9 years) received edgewise treatment alone. The pressure and velocity of the PA were compared between the groups using CFD based on three-dimensional CBCT images of the PA. Results: The change in oropharyngeal airway velocity in the Herbst group (1.95 m/s) was significantly larger than that in the control group (0.67 m/s). Similarly, the decrease in laryngopharyngeal airway velocity in the Herbst group (1.37 m/s) was significantly larger than that in the control group (0.57 m/s). Conclusion: The Herbst appliance improves ventilation of the oropharyngeal and laryngopharyngeal airways. These results may provide a useful assessment of obstructive sleep apnea treatment during growth.

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Isono, Shiroh, Atsuko Tanaka, Yugo Tagaito, Teruhiko Ishikawa, and Takashi Nishino. "Influences of head positions and bite opening on collapsibility of the passive pharynx." Journal of Applied Physiology 97, no. 1 (July 2004): 339–46. http://dx.doi.org/10.1152/japplphysiol.00907.2003.

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A collapsible tube surrounded by soft material within a rigid box was proposed as a two-dimensional mechanical model for the pharyngeal airway. This model predicts that changes in the box size (pharyngeal bony enclosure size anatomically defined as cross-sectional area bounded by the inside edge of bony structures such as the mandible, maxilla, and spine, and being perpendicular to the airway) influence patency of the tube. We examined whether changes in the bony enclosure size either with head positioning or bite opening influence collapsibility of the pharyngeal airway. Static mechanical properties of the passive pharynx were evaluated in anesthetized, paralyzed patients with sleep-disordered breathing before and during neck extension with bite closure ( n = 11), neck flexion with bite closure ( n = 9), and neutral neck position with bite opening ( n = 11). Neck extension significantly increased maximum oropharyngeal airway size and decreased closing pressures of the velopharynx and oropharynx. Notably, neck extension significantly decreased compliance of the oropharyngeal airway wall. Neck flexion and bite opening decreased maximum oropharyngeal airway size and increased closing pressure of the velopharynx and oropharynx. Our results indicate the importance of neck and mandibular position for determining patency and collapsibility of the passive pharynx.

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Mukadder, Sanli, Begec Zekine, Kayhan Gulay Erdogan, Ozgul Ulku, Ucar Muharrem, Yologlu Saim, and Durmus Mahmut. "Comparison of the Proseal, Supreme, and I-Gel SAD in Gynecological Laparoscopic Surgeries." Scientific World Journal 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/634320.

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We compared proseal, supreme, and i-gel supraglottic airway devices in terms of oropharyngeal leak pressures and airway morbidities in gynecological laparoscopic surgeries. One hundred and five patients undergoing elective surgery were subjected to general anesthesia after which they were randomly distributed into three groups. Although the oropharyngeal leak pressure was lower in the i-gel group initially (mean ± standard deviation; 23.9 ± 2.4, 24.9 ± 2.9, and 20.9 ± 3.5, resp.), it was higher than the proseal group and supreme group at 30 min of surgery after the trendelenburg position (25.0 ± 2.3, 25.0 ± 1.9, and 28.3 ± 2.3, resp.) and at the 60 min of surgery (24.2 ± 2.1, 24.8 ± 2.2, and 29.5 ± 1.1, resp.). The time to apply the supraglottic airway devices was shorter in the i-gel group (12.2 (1.2), 12.9 (1.0), and 6.7 (1.2), resp.,P=0.001). There was no difference between the groups in terms of their fiber optic imaging levels. pH was measured at the anterior and posterior surfaces of the pharyngeal region after the supraglottic airway devices were removed; the lowest pH values were 5 in all groups. We concluded that initial oropharyngeal leak pressures obtained by i-gel were lower than proseal and supreme, but increased oropharyngeal leak pressures over time, ease of placement, and lower airway morbidity are favorable for i-gel.

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Boufflers, E., D. Maslowski, H. Menu, T. Guermouche, G. Theeten, D. Beague, H. Reyford, and R. Krivosic-Horber. "Utilisation clinique du COPA (cuffed oropharyngeal airway)." Annales Françaises d'Anesthésie et de Réanimation 17, no. 3 (March 1998): 206–9. http://dx.doi.org/10.1016/s0750-7658(98)80001-4.

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Patel, A., and A. Pearce. "Cuffed oropharyngeal airway (COPA) and pharyngeal tumours." Anaesthesia 53, no. 10 (October 1998): 1032. http://dx.doi.org/10.1046/j.1365-2044.1998.0669f.x.

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Koga, K., M. Kaku, T. Sata, and A. Shigematsu. "Effective use of the cuffed oropharyngeal airway." Anaesthesia 53, no. 7 (July 1998): 715–16. http://dx.doi.org/10.1046/j.1365-2044.1998.537g-az0584g.x.

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Chen, Chun-Ming, Steven Lai, Ker-Kong Chen, and Huey-Er Lee. "Correlation between the Pharyngeal Airway Space and Head Posture after Surgery for Mandibular Prognathism." BioMed Research International 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/251021.

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Purpose. The aim of this study was to determine the correlation between the pharyngeal airway space and head posture after mandibular setback surgery for mandibular prognathism.Materials and Methods. Serial lateral cephalograms of 37 patients with mandibular prognathism who underwent intraoral vertical ramus osteotomy (IVRO) were evaluated before (T1) and immediately (T2), between 6 weeks and 3 months (T3), and more than 1 year (T4) after surgery. Pairedt-tests and Pearson’s correlation analysis were used to evaluate the postoperative changes in all cephalometric parameters, including the mandible, hyoid, head posture (craniocervical angle), and pharyngeal airway space.Results. The mandible and hyoid were set back by 12.8 mm and 4.9 mm, respectively, at T2. Furthermore, the hyoid showed significant inferior movement of 10.7 mm, with an 8 mm increase in the tongue depth. The upper oropharyngeal airway (UOP) shortened by 4.1 mm, the lower oropharyngeal airway (LOP) by 1.7 mm, and the laryngopharyngeal airway by 2 mm. The craniocervical angle showed a significant increase of 2.8°. UOP and LOP showed a significant correlation with the craniocervical angle at T2 and T4.Conclusions. Our findings conclude that the oropharyngeal airway space is significantly decreased and correlated with a change in the head posture after mandibular setback surgery.

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Sharma, R. "Cuffed oropharyngeal airway-assisted Bougie-guided intubation in a difficult airway." Acta Anaesthesiologica Scandinavica 52, no. 10 (October 17, 2008): 1435. http://dx.doi.org/10.1111/j.1399-6576.2008.01769.x.

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Ohmae, Yukio, Jeri A. Logemann, David G. Hanson, Peter Kaiser, and Peter J. Kahrilas. "Effects of Two Breath-Holding Maneuvers on Oropharyngeal Swallow." Annals of Otology, Rhinology & Laryngology 105, no. 2 (February 1996): 123–31. http://dx.doi.org/10.1177/000348949610500207.

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This study quantified the effects of the supraglottic maneuver (SGM) and super supraglottic maneuver (SSGM) on laryngeal and pharyngeal movements before and during swallow. Simultaneous videofluoroscopic and videoendoscopic examinations of oropharyngeal swallowing were performed in eight healthy volunteers with and without maneuvers. Data analysis compared 1) temporal relationships of oropharyngeal events, 2) airway conditions at the time of selected oropharyngeal events, and 3) biomechanical computer analysis of swallowing events. Using these maneuvers, normal subjects produced earlier cricopharyngeal opening, prolonged pharyngeal swallow, some degree of laryngeal valving before swallow, and change in extent of vertical laryngeal position before swallow. These changes are more successful and maintained longer with the SSGM than the SGM. We concluded that breath-holding maneuvers alter not only airway conditions before swallow but also both the temporal relationships and biomechanical events during oropharyngeal swallow.

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Page, Sangeeta, and Anuradha Karande. "Comparison of Laryngeal Mask Airway (LMA) & Cuffed Oropharyngeal Airway (COPA) in Spontaneously Breathing Anaesthetized Patients for Short Surgical Procedure." Indian Journal of Anesthesia and Analgesia 6, no. 2 (2019): 474–81. http://dx.doi.org/10.21088/ijaa.2349.8471.6219.18.

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Na, Ji Sung, Hwi-Dong Jung, Hyung-Ju Cho, Yoon Jeong Choi, and Joon Sang Lee. "Computational analysis of airflow dynamics for predicting collapsible sites in the upper airways: a preliminary study." Journal of Applied Physiology 126, no. 2 (February 1, 2019): 330–40. http://dx.doi.org/10.1152/japplphysiol.00522.2018.

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The present study aimed to detail the relationship between the flow and structure characteristics of the upper airways and airway collapsibility in obstructive sleep apnea. Using a computational approach, we performed simulations of the flow and structure of the upper airways in two patients having different facial morphologies: retruding and protruding jaws, respectively. First, transient flow simulation was performed using a prescribed volume flow rate to observe flow characteristics within upper airways with an unsteady effect. In the retruding jaw, the maximum magnitude of velocity and pressure drop with velocity shear and vortical motion was observed at the oropharyngeal level. In contrast, in the protruding jaw, the overall magnitude of velocity and pressure was relatively small. To identify the cause of the pressure drop in the retruding jaw, pressure gradient components induced by flow were examined. Of note, vortical motion was highly associated with pressure drop. Structure simulation was performed to observe the deformation and collapsibility of soft tissue around the upper airways using the surface pressure obtained from the flow simulation. At peak flow rate, the soft tissue of the retruding jaw was highly expanded, and a collapse was observed at the oropharyngeal and epiglottis levels. NEW & NOTEWORTHY Aerodynamic characteristics have been reported to correlate with airway occlusion. However, a detailed mechanism of the phenomenon within the upper airways and its impact on airway collapsibility remain poorly understood. This study provides in silico results for aerodynamic characteristics, such as vortical structure, pressure drop, and exact location of the obstruction using a computational approach. Large deformation of soft tissue was observed in the retruding jaw, suggesting that it is responsible for obstructive sleep apnea.

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Gupta, Swathi, and Ravi M. Subrahmanya. "Assessment of Oropharyngeal Widths in Individuals with Different Facial Skeletal Patterns." Journal of Health and Allied Sciences NU 04, no. 02 (June 2014): 034–38. http://dx.doi.org/10.1055/s-0040-1703761.

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Abstract: Background and objectives: The relationship between airway patency and craniofacial development is highly debated and controversial subject. Hence this was conducted with the aims and objectives of comparing and correlating the upper & lower Oropharyngeal widths in individuals with horizontal growth pattern with that of individuals having vertical growth pattern. Methodology: 60 subjects (30 males & 30 females) in the age group of 16 to 20 years were selected as per inclusion criteria. They were divided into two groups (Group I and Group II) according to their skeletal pattern in vertical plane based on Jarabak' sratio and Y axis. . Pharyngeal width measurement was done based on McNamara analysis The data obtained was statistically evaluated using Mann-Whitney U test (Z test). Results: Significant correlation was found between facial skeletal patterns and upper and lower Oropharyngeal widths. The subjects with vertical skeletal pattern were found to have significantly narrower upper airways and broader lower airways than those with horizontal skeletal pattern. Interpretation and conclusion: The study supports the existence of a relationship between facial skeletal patterns and upper and lower oropharyngeal widths.

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Kihara, Shinichi, Joseph R. Brimacombe, Yuichi Yaguchi, Noriko Taguchi, and Seiji Watanabe. "A Comparison of Sex- and Weight-based ProSeal™ Laryngeal Mask Size Selection Criteria." Anesthesiology 101, no. 2 (August 1, 2004): 340–43. http://dx.doi.org/10.1097/00000542-200408000-00014.

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Background The authors compared the manufacturer's weight-based formula (size 3 for weight < 50 kg, size 4 for weight 50-70 kg, and size 5 for weight > 70 kg) with a sex-based formula (size 4 for women and size 5 for men) for selecting the appropriate size of ProSeal laryngeal mask airway. Methods Two hundred thirty-seven healthy, anesthetized, paralyzed adult patients (American Society of Anesthesiologists physical status I or II; age, 18-80 yr) were randomly allocated for weight- or sex-based size selection. An experienced user inserted the ProSeal laryngeal mask airway with the digital technique. The following were compared: ease of insertion, oropharyngeal leak pressure, ease of ventilation, gas exchange, location of gas leak, anatomic position, mucosal injury, and postoperative pharyngolaryngeal problems. Intraoperative and postoperative data collection were unblinded and blinded, respectively. Results Ease of insertion, anatomic position, gas exchange, mucosal injury, and postoperative pharyngolaryngeal problems were similar between groups. For the sex-based group, larger ProSeal laryngeal mask airways were selected more frequently (P < 0.0001), oropharyngeal leak pressure (P = 0.02) was higher, leak volume (P = 0.004) and leak fraction (P = 0.007) were lower, and oropharyngeal leaks (P = 0.03) were detected less frequently. Conclusion Size selection for the ProSeal laryngeal mask airway is equally effective using the manufacturer's weight-based formula or the sex-based formula in healthy, anesthetized, paralyzed adult patients, but leakage of small volumes of air from the mouth occurs less frequently with the sex-based formula.

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Ayres, Allen W., and Suzanne K. Pugh. "Ex Utero Intrapartum Treatment for Fetal Oropharyngeal Cyst." Obstetrics and Gynecology International 2010 (2010): 1–3. http://dx.doi.org/10.1155/2010/273410.

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Background. A prenatally diagnosed fetal anomaly that could compromise the fetal airway at delivery can be managed safely with the ex utero intrapartum treatment (EXIT) procedure.Case. A 26-year-old healthy primigravida was diagnosed during her midtrimester anatomic ultrasound survey with a fetal oropharyngeal cystic structure located at the base of the tongue. The neonatal airway was successfully secured intrapartum using the EXIT procedure.Conclusion. Maintenance of fetoplacental circulation until the fetal airway is secured has been described for a multitude of fetal anomalies including cystic hygroma and teratoma. The literature also recounts its use for the reversal of tracheal plugging for congenital diaphragmatic hernia. A multidisciplinary approach to the antenatal and intrapartum care is essential for the successful management of these cases.

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Wheatley, J. R., W. T. Kelly, A. Tully, and L. A. Engel. "Pressure-diameter relationships of the upper airway in awake supine subjects." Journal of Applied Physiology 70, no. 5 (May 1, 1991): 2242–51. http://dx.doi.org/10.1152/jappl.1991.70.5.2242.

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In awake supine normal subjects, dimensional changes of the oropharyngeal airway were measured during exposure to negative intraluminal pressures. The pressure was generated 1) "actively" by subjects inspiring against an externally occluded airway or 2) "passively" by external suction at the mouth during voluntary glottic closure with no inspiratory effort. Airway dimensions were imaged with X-ray fluoroscopy and anteroposterior diameters measured at levels corresponding to cervical vertebra 3 and 4 (C3 and C4). Cephalad axial displacement of the hyoid bone (CDHY) was also measured. During the "active" maneuver, airway diameters and position were maintained at resting levels despite airway pressure up to -15 cmH2O. In contrast, during the passive maneuver at -15 cmH2O, C3 was only 15 +/- 9% and C4 only 47 +/- 8% of control; CDHY was 5.6 +/- 1.8 mm. In three subjects airway wall apposition occurred and persisted until an active inspiratory effort. We conclude that, in the absence of inspiratory effort, negative oropharyngeal airway pressures result in marked narrowing and cephalad displacement of the upper airway, even during wakefulness. Therefore, our data suggest that the complex interaction of upper airway and thoracic muscle activity is critical in determining the effective compliance and patency of the upper airway, which is readily collapsible even in normal subjects.

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Keller, C., and J. Brimacombe. "Mucosal pressures from the cuffed oropharyngeal airway vs the laryngeal mask airway." British Journal of Anaesthesia 82, no. 6 (June 1999): 922–24. http://dx.doi.org/10.1093/bja/82.6.922.

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Al-Fahdawi, Mahmood Abd, Marwa Abdelwahab El-Kassaby, Mary Medhat Farid, and Mona Abou El-Fotouh. "Cone Beam Computed Tomography Analysis of Oropharyngeal Airway in Preadolescent Nonsyndromic Bilateral and Unilateral Cleft Lip and Palate Patients." Cleft Palate-Craniofacial Journal 55, no. 6 (February 22, 2018): 883–90. http://dx.doi.org/10.1597/15-322.

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Objective: The objective of this study was to assess the volume, area, and dimensions of the oropharyngeal airway (OPA) in a previously repaired nonsyndromic unilateral cleft lip and palate (UCLP) versus bilateral cleft lip and palate (BCLP) patients when compared with noncleft controls using cone beam computed tomography (CBCT). Design: This was a retrospective case-control study. Setting: The Cleft Care Center and outpatient clinic that are affiliated to our faculty were the settings for the study. Participants: A total of 58 CBCT scans were selected of preadolescent individuals: 14 BCLP, 20 UCLP, and 24 age- and gender-matched noncleft controls. Variables: Variables were volume, cross-sectional area (CSA), midsagittal area (MSA), and dimensions of OPA. Statistical analysis: One-way analysis of variance and post hoc tests were used to compare variables. Statistical significance was set at P ≤ .05. Results: UCLP showed significantly smaller superior oropharyngeal airway volume than both controls and BCLP ( P ≤ .05). BCLP showed significantly larger CSA at soft palate plane and significantly larger MSA than both UCLP and controls ( P < .05). Conclusions: UCLP patients at the studied age and stage of previously repaired clefts have significantly less superior oropharyngeal airway volume than both controls and BCLP patients. This confirms that preadolescents with UCLP are at greater risk for superior oropharyngeal airway obstruction when compared with those BCLP and controls. Furthermore, BCLP patients showed significantly larger CSA at soft palate plane and MSA than both controls and UCLP patients. These variations in OPA characteristics of cleft patients can influence function in terms of respiration and vocalization.

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Kim, Ha-Jung, Hee-Sun Park, Soo-Young Kim, Young-Jin Ro, Hong-Seuk Yang, and Won Uk Koh. "A Randomized Controlled Trial Comparing Ambu AuraGain and i-gel in Young Pediatric Patients." Journal of Clinical Medicine 8, no. 8 (August 16, 2019): 1235. http://dx.doi.org/10.3390/jcm8081235.

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Supraglottic airway devices have been increasingly used because of their several advantages. Previous studies showed that the small-sized i-gel provides effective ventilation for young pediatric patients; however, few studies have reported the use of AuraGain in these patients. Herein, we compared the clinical performance of AuraGain and i-gel in young pediatric patients aged between 6 months and 6 years old and weighing 5–20 kg, who were scheduled to undergo extremity surgery under general anesthesia. In total, 68 patients were enrolled and randomly allocated into two groups: AuraGain group and i-gel group. The primary outcome was the requirement of additional airway maneuvers. We also analyzed insertion parameters, fiberoptic bronchoscopic view, oropharyngeal leak pressure, and peri-operative adverse effects. Compared with the AuraGain group, the i-gel group required more additional airway maneuvers during the placement of the device and maintenance of ventilation. The fiberoptic view was better in the AuraGain group than in the i-gel group. However, the oropharyngeal leak pressure was higher in the i-gel group. AuraGain might be a better choice over i-gel considering the requirement of additional airway maneuvers. However, when a higher oropharyngeal leak pressure is required, the i-gel is more beneficial than AuraGain.

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Lee, Crystine M., Kenneth S. Song, Bill R. Morgan, David C. Smith, John B. Smithson, Robert W. Sloane, and Michael S. Hickey. "Aspiration of an Oropharyngeal Airway during Nasotracheal Intubation." Journal of Trauma: Injury, Infection, and Critical Care 50, no. 5 (May 2001): 937–38. http://dx.doi.org/10.1097/00005373-200105000-00029.

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Beydon, L., A. M. Lorino, F. Lofaso, L. Delaunay, P. Catoire, and F. Bonnet. "OROPHARYNGEAL TOPICAL ANESTHESIA INCREASES AIRWAY RESISTANCES IN MAN." Anesthesiology 77, Supplement (September 1992): A1223. http://dx.doi.org/10.1097/00000542-199209001-01223.

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Reddy, Jayaprakash Thirumala, Vinod Abraham Korath, Naveen Reddy Adamala, Gopinath Adusumilli, Saravanan Pichai, and KVV Prathap Varma. "Cephalometric Evaluation of Oropharyngeal Airway Dimension Changes in Pre- and Postadenoidectomy Cases." Journal of Contemporary Dental Practice 13, no. 6 (2012): 764–68. http://dx.doi.org/10.5005/jp-journals-10024-1226.

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ABSTRACT Aim The aim is to compare and evaluate the airway dimension changes, adenoidal nasopharyngeal ratio (ANR), airway area and airway percentage in patients in pre- and postadenoidectomy with normal individuals. Materials and methods After obtaining informed consent, a sample of 15 patients (eight males and seven females) of 7 to 12 years were selected for adenoidectomy by an otolaryngologist, lateral cephalograms were taken in natural head position before adenoidectomy and after 1 month postadenoidectomy. Statastical analysis was done to evaluate the results using Statastical Package for Social Sciences. Results showed airway (P1, P2, P3, P4), airway percentage, airway area showed singinficant increase (p < 0.0001), whereas ANR showed singnificant reduction after 1 month postadenoidectomy. Conclusion One month postadenoidectomy showed increased airway area, airway percentage and reduced ANR. Clinical significance Obstructive mouth breathing due to adenoids in growing children can cause alteration in craniofacial morphology leading to adenoid facies, adenoidectomy procedure helps in alleviating the obstruction and facilitates the normal growth of craniofacial complex. How to cite this article Reddy JT, Korath VA, Adamala NR, Adusumilli G, Pichai S, Varma KVVP. Cephalometric Evaluation of Oropharyngeal Airway Dimension Changes in Pre- and Postadenoidectomy Cases. J Contemp Dent Pract 2012; 13(6):764-768.

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Verma, Reetu, Nitin Kumar, Hemlata ., Sateesh Verma, and Dinesh Singh. "A comparative evaluation of I-gel and laryngeal mask airway supreme in laparoscopic surgeries: a randomized comparative study." International Journal of Research in Medical Sciences 7, no. 12 (November 27, 2019): 4600. http://dx.doi.org/10.18203/2320-6012.ijrms20195525.

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Background: Supraglottic airway device results in less hemodynamic responses during laparoscopic surgery but supraglottic airway device to be used should have higher oropharyngeal seal pressure than peak pressure for effective ventilation as laparoscopic surgery also leads to higher airway pressure. In this study the efficiency of the I-gel with SLMA is compared in patients undergoing laparoscopic cholecystectomy surgeries.Methods: Sixty patients were randomized in to two groups, group A where I-gel was considered for airway management and group B where LMA Supreme was the device chosen for airway management.Results: Oropharyngeal seal pressure was significantly lower in group A than group B, 5 minutes after insertion of airway device it was 24.90±3.03 cm H2O and 27.30±3.41 cm H2O in group A and group B, respectively and 5 minutes after creation of pneumoperitoneum it was 25.53±3.17 cm H2O and 27.57±3.36 cm H2O in group A and group B, respectively. There was significant difference in the difference between inspiratory and expiratory tidal volume between the groups at all the time periods being higher in group A than group B. Hemodynamics were comparable between the two groups. Time taken to insert the airway device and Ryle’s tube insertion was significantly lesser in group B in comparison to group A. The percentage of complications was higher in group A than group B with no significant (p>0.05) association.Conclusions: Both the I-gel and SLMA devices can be used safely in laparoscopic cholecystectomy in non-obese patients. But in SLMA group oropharyngeal seal pressure was higher with lesser leak volume in comparison to I-gel group.

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Journal articles on the topic 'Oropharyngeal airway'

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