A two-handed airway maneuver of mandibular advancement and mouth opening in the neutral neck position for immobilization of the cervical spine

• Published in: Journal of anesthesia Vol. 35; no. 6; pp. 811 - 817
• Main Authors: Sawada, Atsushi, Ochiai, Gen, Yamakage, Michiaki
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.12.2021; Springer
• Subjects: Anesthesiology; Cervical Vertebrae; Critical Care Medicine; Emergency Medicine; Humans; Intensive; Mandibular Advancement; Medical colleges; Medicine; Medicine & Public Health; Movement; Neck; Original Article; Pain Medicine; Tidal Volume; Japan; Mandibular advancement; Neutral neck position; Two-handed airway maneuver; Mouth opening
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-021-02981-1

Purpose Immobilization of the cervical spine after trauma is recommended as standard care to prevent secondary injury. We tested the hypothesis that a two-handed airway maneuver, consisting of mandibular advancement and mouth opening in the neutral neck position, would minimize changes in the angle of the cervical vertebrae at the C0/4 level and tidal volume in non-obese patients under anesthesia with neuromuscular blockade. Methods Twenty consecutive patients without cervical spine injury undergoing general anesthesia were enrolled and evaluated. The primary variable was change in the angle of the cervical vertebrae at the C0/4 level during mask ventilation using the modified two-handed technique. Secondary variables included changes in the angles of the cervical vertebrae at each level between C0 and C4, anterior movement of the vertebral bodies, change in the angle between the head and neck, change in the pharyngeal airway space, and tidal volume during mask ventilation. Results The two-handed airway maneuver of mandibular advancement and mouth opening resulted in statistically significant changes in the angle of the cervical spine at the C0/4 level (3.2 ± 3.0 degrees, P  < 0.001) and the C3/4 level (1.4 ± 2.2 degrees, P  = 0.01). The two-handed airway maneuver provided adequate mask ventilation without anterior movement of the vertebral bodies. Conclusion Our study suggests that a two-handed airway maneuver of mandibular advancement and mouth opening in the neutral neck position results in only slight change in the cervical vertebral angle at the C0/4 level in non-obese patients under general anesthesia with neuromuscular blockade.