Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.12.002
Brazilian Journal of Anesthesiology
Clinical Research

Airway patency in children undergoing magnetic resonance imaging using neck collars: a single center, randomized, double-blind, prospective study

Permeabilidade da via aérea com o uso de colar cervical em crianças submetidas a ressonância magnética: estudo prospectivo, randomizado, duplo-cego, unicêntrico

Gulseren Yilmaz, Kenan Varol, Osman Esen, Arda Kayhan, Ziya Salihoglu

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Abstract

Background and objectives
: Maneuvers precluding the downward shift of the mandibula and providing slight extension of the head have been shown to increase upper airway dimensions. This study aimed to investigate the role of Neck Collars (NC) in maintaining airway patency during Magnetic Resonance Imaging (MRI) examination in a pediatric population aged between 0 and 16 years.

Methods
One hundred twenty-five children were recruited in this prospective study. Subjects were randomly assigned to NC group (NC+) or standard imaging group (NC-). Measurements of anteroposterior and transverse dimensions and cross-sectional area were performed to determine the upper airway size at three distinct levels: soft palate, base of the tongue, and tip of the epiglottis.

Results
The anteroposterior diameter and cross-sectional area at the levels of base of the tongue and soft palate were significantly higher in NC + patients compared to NC- patients. However, anteroposterior dimensions and cross-sectional areas at the epiglottis level were similar in the two groups. When patients were analyzed according to age groups of 0–2, 2–8, and 8–16 years, the anteroposterior diameter and cross-sectional area at the levels of base of the tongue and soft palate were significantly higher in NC + patients compared to NC- patients in all age groups.

Conclusions
This study clearly demonstrates that the application of a NC may improve retropalatal end and retroglossal airway dimensions in a pediatric population undergoing MRI examination and receiving sedation in supine position.

Keywords

Airway;  Children;  Magnetic resonance imaging;  Deep sedation

Resumo

Introdução e objetivos
Manobras que impedem o deslocamento posterior da mandíbula e que proporcionam leve extensão da cabeça aumentam as dimensões da via aérea superior. Tivemos como objetivo estudar o papel desempenhado pelo Colar Cervical (CC) na manutenção da permeabilidade da via aérea durante o exame de Ressonância Magnética (RM) em uma população pediátrica com idade entre 0 e 16 anos.

Métodos
Neste estudo prospectivo foram recrutadas 125 crianças. Os participantes foram distribuídos aleatoriamente para realizar o exame de RM usando + (grupo com CC) ou para realizar o exame de RM padrão, sem o uso do CC- (grupo sem CC). As medições dos diâmetros anteroposterior e transverso e da área da seção transversal foram realizadas para determinar o tamanho da via aérea superior em três níveis distintos: palato mole, base da língua e ponta da epiglote.

Resultados
O diâmetro anteroposterior e a área da seção transversal no nível da base da língua e do palato mole foram significantemente maiores no grupo CC + em comparação ao grupo CC-. No entanto, o diâmetro anteroposterior e a área da seção transversal no nível da epiglote foram semelhantes nos dois grupos. Quando os pacientes foram analisados ​​segundo as faixas etárias de 0–2, 2–8 e 8–16 anos, o diâmetro anteroposterior e a área da seção transversal no nível da base da língua e do palato mole foram significantemente maiores no grupo CC + comparados aos valores observados no grupo CC-, para todas as faixas etárias.

Conclusões
Este estudo demonstra claramente que o uso do colar cervical pode melhorar as dimensões da área retrolingual e da extremidade retropalatal da via aérea em uma população pediátrica na posição supina, durante a realização de exame de ressonância magnética sob sedação.

References

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