scholarly journals Effects on the Upper Airway Morphology with Intravenous Addition of Ketamine after Dexmedetomidine Administration in Normal Children

2020 ◽  
Vol 9 (11) ◽  
pp. 3723
Author(s):  
Goutham Mylavarapu ◽  
Robert J. Fleck ◽  
Michale S. Ok ◽  
Lili Ding ◽  
Ali Kandil ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Upper Airway ◽  
Region Growing ◽  
Final Analysis ◽  
Normal Children ◽  
Cross Sectional ◽  
Pharyngeal Airway ◽  
Airway Morphology ◽  
Dexmedetomidine Infusion ◽  
Airway Dimensions

General anesthesia decreases the tone of upper airway muscles in a dose-dependent fashion, potentially narrowing the pharyngeal airway. We examined the effects of adding ketamine on the airway configuration after dexmedetomidine administration in spontaneously breathing children with normal airways. 25 children presenting for Magnetic Resonance Imaging (MRI) of the brain/spine under general anesthesia were prospectively recruited in the study. Patients were anesthetized with dexmedetomidine bolus (2 mcg over 10 min) followed by dexmedetomidine infusion (2 mcg·kg−1·h) and ketamine and permitted to breathe spontaneously via the native airway. MR-CINE images of the upper airway were obtained with dexmedetomidine infusion alone (baseline) and 5, 10, and 15 min after administering ketamine bolus (2 mg·kg−1) in two anatomical axial planes at the nasopharynx and the retroglossal upper airway. Airway lumen is segmented with a semi-automatic image processing approach using a region-growing algorithm. Outcome measures of cross-sectional area, transverse and anterior-posterior diameters of the airway in axial planes at the level of the epiglottis in the retroglossal airway, and in the superior nasopharynx were evaluated for changes in airway size with sedation. Airway dimensions corresponding to the maximum, mean, and minimum sizes during a respiratory cycle were obtained to compare the temporal changes in the airway size. The dose-response of adding ketamine to dexmedetomidine alone condition on airway dimensions were examined using mixed-effects of covariance models. 22/25 patients based on inclusion/exclusion criteria were included in the final analysis. The changes in airway measures with the addition of ketamine, when compared to the baseline of dexmedetomidine alone, were statistically insignificant. The modest changes in airway dimensions are clinically less impactful and within the accuracy of the semi-automatic airway segmentation approach. The effect sizes were small for most airway measures. The duration of ketamine seems to not affect the airway size. In conclusion, adding ketamine to dexmedetomidine did not significantly reduce upper airway configuration when compared to dexmedetomidine alone.

A Versatile IBM-Based AMR Method for Studying Human Snoring

2021 ◽  
Author(s):  
Wei Zhang ◽  
Yu Pan ◽  
Yuchen Gong ◽  
Haibo Dong ◽  
Jinxiang Xi
Keyword(s):  
Adaptive Mesh Refinement ◽  
Stokes Equations ◽  
Flow Behavior ◽  
Upper Airway ◽  
Magnetic Resonance Images ◽  
Immersed Boundary ◽  
Cross Sectional ◽  
Pharyngeal Airway ◽  
Aerodynamic Pressure ◽  
Head Neck

Abstract In this work, a local adaptive mesh refinement (AMR) embedded incompressible flow solver is developed for biomedical flows. This AMR technique is based on the block-structured mesh and adapted from an in-house numerical solver for the Navier-Stokes equations with immersed-boundary method embedded, which is suitable for flows with complex and moving boundaries in biomedical applications. Flow behavior of the human upper airway under various head-neck postures is evaluated using the developed AMR technique, where the head-neck posture is hypothesized to change the cross-sectional area of the airway, therefore the airflow and aerodynamic behavior. The anatomically accurate three-dimensional human upper airway model is reconstructed from human magnetic resonance images (MRI) with measurements from the literature. Analyses were performed on vortex dynamics and pressure fluctuations in the pharyngeal airway. It was found that the vortex formation and aerodynamic pressure were affected by the airway bending. The sniffing position or the head-neck junction extension posture tend to facilitate the airflow through the upper human airway.

scholarly journals The influence of craniofacial morphology on the upper airway dimensions

2014 ◽  
Vol 85 (5) ◽  
pp. 874-880 ◽  
Author(s):  
Iveta Indriksone ◽  
Gundega Jakobsone
Keyword(s):  
Linear Regression Analysis ◽  
Upper Airway ◽  
Correlation Coefficients ◽  
Craniofacial Morphology ◽  
Multivariate Linear Regression Analysis ◽  
Cross Sectional ◽  
Old Patients ◽  
Oropharyngeal Airway ◽  
Semiautomatic Segmentation ◽  
Airway Dimensions

ABSTRACT Objective:  To evaluate the influence of craniofacial morphology on the upper airway dimensions in healthy adult subjects. Materials and Methods:  The records of 276 healthy 17- to 27-year-old patients were extracted from the cone-beam computed tomography image database of the Institute of Stomatology, Riga Stradins University. Dolphin 11.7 software was used to evaluate craniofacial anatomy and semiautomatic segmentation of the upper airway. Measurements of oropharyngeal airway volume (OPV), minimal cross-sectional area (CSAmin), and nasopharyngeal airway volume (NPV) were obtained. The presence of adenoid tissues was recorded. Associations between variables were analyzed by Spearman's correlation coefficients, and multivariate linear regression analysis was used to identify factors that had a possible influence on upper airway dimensions. Results:  The following factors were identified as influencing the variability of NPV (23%): SNA angle, gender, and presence of adenoids. Statistically significant, although weak, correlations were found between SNB angle and OPV (r  =  0.144, P < .05) and CSAmin (r  =  0.182, P < .01). Conclusion:  The results suggest that craniofacial morphology alone does not have a significant influence on upper airway dimensions.

Developmental changes in upper airway dynamics

2004 ◽  
Vol 97 (1) ◽  
pp. 98-108 ◽  
Author(s):  
Carole L. Marcus ◽  
Lucila B. Fernandes Do Prado ◽  
Janita Lutz ◽  
Eliot S. Katz ◽  
Cheryl A. Black ◽  
...  
Keyword(s):  
Upper Airway ◽  
Older Children ◽  
Normal Children ◽  
Compensatory Response ◽  
Pharyngeal Airway ◽  
Ventilatory Drive ◽  
Airway Response ◽  
Airway Responses ◽  
Airway Dynamics ◽  
Normal Adults

Normal children have a less collapsible upper airway in response to subatmospheric pressure administration (PNEG) during sleep than normal adults do, and this upper airway response appears to be modulated by the central ventilatory drive. Children have a greater ventilatory drive than adults. We, therefore, hypothesized that children have increased neuromotor activation of their pharyngeal airway during sleep compared with adults. As infants have few obstructive apneas during sleep, we hypothesized that infants would have an upper airway that was resistant to collapse. We, therefore, compared the upper airway pressure-flow (V̇) relationship during sleep between normal infants, prepubertal children, and adults. We evaluated the upper airway response to 1) intermittent, acute PNEG (infants, children, and adults), and 2) hypercapnia (children and adults). We found that adults had a more collapsible upper airway during sleep than either infants or children. The children exhibited a vigorous response to both PNEG and hypercapnia during sleep ( P < 0.01), whereas adults had no significant change. Infants had an airway that was resistant to collapse and showed a very rapid response to PNEG. We conclude that the upper airway is resistant to collapse during sleep in infants and children. Normal children have preservation of upper airway responses to PNEG and hypercapnia during sleep, whereas responses are diminished in adults. Infants appear to have a different pattern of upper airway activation than older children. We speculate that the pharyngeal airway responses present in normal children are a compensatory response for a relatively narrow upper airway.

scholarly journals Mandibular morphology and pharyngeal airway space: A cephalometric study

2014 ◽  
Vol 5 ◽  
pp. 22-28 ◽  
Author(s):  
Siddharth Mehta ◽  
Surendra Lodha ◽  
Ashima Valiathan ◽  
Arun Urala
Keyword(s):  
Upper Airway ◽  
Normal Subjects ◽  
Cross Sectional Study ◽  
Craniofacial Morphology ◽  
Cross Sectional ◽  
Mandibular Prognathism ◽  
Pharyngeal Airway ◽  
Significant Difference ◽  
Mandibular Morphology ◽  
Mandibular Retrognathism

Introduction Mandibular retrognathism is considered to be the most important risk factor for upper airway obstruction. Aim This cross-sectional study intended to examine the relationship between craniofacial morphology and the pharyngeal airway space (PAS) in patients with mandibular retrognathism and mandibular prognathism, when compared to normal subjects. The study also analyzed the influence of mandibular morphology on pharyngeal length (PL). Materials and Methods The PAS was assessed in 92 females (age 15-30 years) further divided into three groups - Group 1- normal mandible (76°≤ SNB ≤82°; n = 31); Group 2-mandibular retrognathism (SNB <76°; n = 31); Group 3-Mandibular prognathism (SNB >82°; n = 30). All subjects were examined by lateral cephalometry with head position standardized using an inclinometer. Craniocervical angulation, uvula length, thickness and angulation were compared among different groups. Results The results showed no statistically significant difference in the pharyngeal airway between the three groups. Measurements of PL showed statistically significant higher values for retrognathic mandible group than normal and prognathic mandible group. Conclusion There is no significant difference between PAS between patients with mandibular retrognathism, normal mandible and mandibular prognathism. Mandibular retrognathism patients show a significantly higher uvula angulation than patients with mandibular prognathism. Craniocervical angulation showed maximum value in retrognathic mandible group followed by normal and prognathic mandible group respectively. Mean PL for retrognathic mandible patients was significantly higher than prognathic mandible patients.

Effect of Increasing Depth of Propofol Anesthesia on Upper Airway Configuration in Children

2003 ◽  
Vol 99 (3) ◽  
pp. 596-602 ◽  
Author(s):  
Russell G. Evans ◽  
Mark W. Crawford ◽  
Michael D. Noseworthy ◽  
Shi-Joon Yoo
Keyword(s):  
Confidence Interval ◽  
Soft Palate ◽  
Upper Airway ◽  
Magnetic Resonance Images ◽  
Cross Sectional Area ◽  
Depth Of Anesthesia ◽  
Sectional Area ◽  
Cross Sectional ◽  
Airway Narrowing ◽  
Pharyngeal Airway

Background The upper airway tends to be obstructed during anesthesia in spontaneously breathing patients. The purpose of the current study was to determine the effect of increasing depth of propofol anesthesia on airway size and configuration in children. Methods Magnetic resonance images of the upper airway were obtained in 15 children, aged 2-6 yr. Cross-sectional area, anteroposterior dimension, and transverse dimension were measured at the level of the soft palate, dorsum of the tongue, and tip of the epiglottis. Images were obtained during infusion of propofol at a rate of 50-80 microg.kg-1.min-1 and after increasing the depth of anesthesia by administering a bolus dose of propofol and increasing the infusion rate to 240 microg.kg-1.min-1. Results Overall, the cross-sectional area of the entire pharyngeal airway decreased with increasing depth of anesthesia. The reduction in cross-sectional area was greatest at the level of the epiglottis (24.5 mm2, 95% confidence interval = 16.9-32.2 mm2; P &lt; 0.0001), intermediate at the level of the tongue (19.3 mm2, 95% confidence interval = 9.2-29.3 mm2; P &lt; 0.0001), and least at the level of the soft palate (12.6 mm2, 95% confidence interval = 2.7-22.6 mm2; P &lt; 0.005) in expiration and resulted predominantly from a reduction in anteroposterior dimension. The airway cross-sectional area decreased further in inspiration at the level of the epiglottis. The narrowest portion of the airway resided at the level of the soft palate or epiglottis in the majority of children. Conclusion Increasing depth of propofol anesthesia in children is associated with upper airway narrowing that occurs throughout the entire upper airway and is most pronounced in the hypopharynx at the level of the epiglottis.

Effect of Combined Mouth Closure and Chin Lift on Upper Airway Dimensions during Routine Magnetic Resonance Imaging in Pediatric Patients Sedated with Propofol

1999 ◽  
Vol 90 (6) ◽  
pp. 1617-1623. ◽  
Author(s):  
Adrian Reber ◽  
Stephan G. Wetzel ◽  
Karl Schnabel ◽  
Georg Bongartz ◽  
Franz J. Frei
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Soft Palate ◽  
Pediatric Patients ◽  
Upper Airway ◽  
Resonance Imaging ◽  
Cross Sectional ◽  
Propofol Sedation ◽  
Routine Magnetic Resonance Imaging ◽  
Airway Dimensions

Background In pediatric patients, obstruction of the upper airway is a common problem during general anesthesia. Chin lift is a commonly used technique to improve upper airway patency. However, little is known about the mechanism underlying this technique. Methods The authors studied the effect of the chin lift maneuver on airway dimensions in 10 spontaneously breathing children (aged 2-11 yr) sedated with propofol during routine magnetic resonance imaging. The minimal anteroposterior and corresponding transverse diameters of the pharynx were determined at the levels of the soft palate, dorsum of the tongue, and tip of the epiglottis before and during the chin lift maneuver. Additionally, cross-sectional areas were calculated at these sites, including tracheal areas 2 cm below the glottic level. Results Minimal anteroposterior diameter of the pharynx increased significantly during chin lift at all three levels in all patients. The diameters of the soft palate, tongue, and epiglottis increased from 6.7+/-2.8 mm (SD) to 9.9+/-3.6 mm, from 9.6+/-3.6 mm to 16.5+/-3.1 mm, and from 4.6+/-2.5 mm to 13.1+/-2.8 mm, respectively. The corresponding transverse diameter of the pharynx also increased significantly at all three levels in all patients but without significant predominance. The diameters at the levels of the soft palate, tongue, and epiglottis increased from 15.8+/-5.1 mm to 22.8+/-4.5 mm, from 13.5+/-4.9 mm to 18.7+/-5.3 mm, and from 17.2+/-3.9 mm to 21.2+/-3.7 mm, respectively. Cross-sectional pharyngeal areas increased significantly at all levels (soft palate, from 0.88+/-0.58 cm2 to 1.79+/-0.82 cm2; tongue, from 1.15+/-0.45 cm2 to 2.99+/-1.30 cm2; epiglottis, from 1.17+/-0.70 cm2 to 3.04+/-0.99 cm2), including the subglottic level (from 0.44+/-0.15 cm2 to 0.50+/-0.14 cm2). Conclusions This study shows that all children had a preserved upper airway at all measured sites during propofol sedation. Chin lift caused a widening of the entire pharyngeal airway that was most pronounced between the tip of the epiglottis and the posterior pharyngeal wall. In pediatric patients, chin lift may be used as a standard procedure during propofol sedation.

scholarly journals Risk factors for small pharyngeal airway dimensions in preorthodontic children: A three-dimensional study

2016 ◽  
Vol 87 (1) ◽  
pp. 138-146 ◽  
Author(s):  
Seerone Anandarajah ◽  
Raahib Dudhia ◽  
Andrew Sandham ◽  
Liselotte Sonnesen
Keyword(s):  
Skeletal Maturity ◽  
Three Dimensional ◽  
Cross Sectional Area ◽  
Craniofacial Morphology ◽  
Sectional Area ◽  
Cross Sectional ◽  
Pharyngeal Airway ◽  
And Gender ◽  
Relevant Factors ◽  
Airway Dimensions

ABSTRACT Objective: To analyze which parameters, gathered from standard orthodontic diagnostic material, were most relevant for identifying small pharyngeal airway dimensions in preorthodontic children. Materials and Methods: The sample was composed of 105 cone beam computed tomography scans of healthy preorthodontic children (44 boys, 61 girls; mean age, 10.7 ± 2.4 years). Airway volume and minimal cross-sectional area were three-dimensionally assessed. Cephalometric features and skeletal maturity were assessed on generated two-dimensional cephalograms. Associations were analyzed and adjusted for age, gender, and skeletal maturity by multiple regression analyses. Results: Airway volume and minimal cross-sectional area were significantly smaller in prepubertal children (P &lt; .001, P &lt; .05, respectively) and positively associated with age (P &lt; .001, P &lt; .01, respectively). After adjustment of age, skeletal maturity and gender significant associations were found between pharyngeal airway dimensions and craniofacial morphology. Airway volume was positively associated with maxillary and mandibular width (P &lt; .01; P &lt; .001, respectively) and anterior face height (P &lt; .05; P &lt; .05, respectively). Minimal cross-sectional area was positively associated with maxillary and mandibular width (P &lt; .01; P &lt; .001, respectively) and negatively associated with sagittal jaw relationship (AnPg, P &lt; .05). Mandibular width and age were the most relevant factors for airway volume (r2 = 0.36). Mandibular width and sagittal jaw relationship were the most relevant factors for minimal cross-sectional area (r2 = 0.16). Conclusion: Pharyngeal airway dimensions were significantly associated with age, skeletal maturity, and craniofacial morphology in all three planes. Children with a reduced mandibular width and increased sagittal jaw relationship are particularly at risk of having small pharyngeal airway dimensions.

scholarly journals THE EFFECT OF ISOLATED SEGMENTAL CHIN OSTEOTOMY (SCO) ON THE PHARYNGEAL AIRWAY SPACE

2020 ◽  
Vol 17 (35) ◽  
pp. 495-506
Author(s):  
Larysa DAKHNO ◽  
Iryna LOGVYNENKO
Keyword(s):  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Fold Increase ◽  
Forward Movement ◽  
Virtual Planning ◽  
Cross Sectional ◽  
Pharyngeal Airway ◽  
Facial Esthetics ◽  
Obstructive Sleep ◽  
The Face

The chin affects facial esthetics and the harmony between frontal and lateral views and is one of the most important anatomic structures of the lower third of the face. Chin osteotomy is aimed at ensuring the harmonization of the facial profile by balancing the size and form of the lower third of the face. It is assumed that the isolated genioplasty surgery will improve the pharyngeal airway space (PAS) by promoting muscle changes, specifically by pulling forward the hyoid bone and decompressing the hypopharynx region. Two patients without obstructive sleep apnea syndrome (OSAS) underwent isolated chin osteotomy for esthetic purposes. Forward movement of the chin by the Pg point was 7 mm in one case and 11 mm in another case. They were evaluated by preoperative and postoperative cone-beam computed tomography scans. The upper airway space was subdivided into retropalatal and retroglossal spaces. After this, the upper airway space was analyzed through the following criteria: 1) three-dimensional, high-altitude, cross-sectional surfaces; 2) transverse and anteroposterior diameter changes. Isolated segmental genioplasty was used after precise virtual planning and resulted in the PAS increase only in one case. There was a relevant correlation between the vertical and horizontal chin change and the hypopharynx. There was an average of a 1.6-fold increase in the total volume of the upper airway space. The retroglossal space was increased 1.5-fold. In another case, there was no relevant correlation between the vertical and horizontal chin change and the PAS. Isolated segmental chin osteotomy provides predictable esthetic results in the correction of different mandible anterior deformities and may contribute to an increased volume and a morphologic airway change. Further studies should be conducted to evaluate the effect of isolated segmental genioplasty on the pharyngeal airway space.

scholarly journals Factors Influencing Upper Airway Dimensions in Skeletal Class Ⅱ Children and Adolescents: A CBCT Study

2021 ◽  
Vol 48 (1) ◽  
pp. 1-11
Author(s):  
Byounghwa Kim ◽  
Jewoo Lee ◽  
Jiyoung Ra
Keyword(s):  
Skeletal Maturity ◽  
Upper Airway ◽  
Craniofacial Morphology ◽  
Cross Sectional ◽  
Skeletal Class ◽  
Factors Influencing ◽  
Facial Height ◽  
One Way Anova ◽  
Relevant Factors ◽  
Airway Dimensions

The purpose of this study is to investigate factors influencing the upper airway dimensions in skeletal Class Ⅱ children and adolescents.In total, 67 patients were selected. Airway volume and minimal cross-sectional area were three-dimensionally assessed. Craniofacial morphology and skeletal maturity were assessed on generated two-dimensional cephalograms. The measurements were analyzed using Mann-Whitney test, one-way ANOVA, Pearson’s correlation, and multiple regression analysis.Upper airway dimensions were significantly smaller in pre-peak stage group, and positively associated with age. Anterior facial height and age were the most relevant factors for airway volume. Mandibular width and age were the most relevant factors for minimal cross-sectional area.Upper airway dimensions were significantly associated with age, skeletal maturity and craniofacial morphology in all three planes.

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