Literature Review for Office-Based Anesthesia

Head rotation is known to increase the cross-sectional area of the upper airway in normal, awake subjects and during drug-induced sleep endoscopy. Head rotation also improves upper airway patency in patients with upper airway obstruction with obstructive sleep apnea. In this randomized crossover study, the authors hypothesized that head rotation would reduce upper airway obstruction and improve tidal volume during mask ventilation of apneic, paralyzed patients. Forty patients, aged 18–75 years and with a body mass index between 18.5 and 35, requiring general anesthesia for elective surgery were studied. Expiratory tidal volume, measured with a respiratory inductive plethysmograph, was recorded immediately after anesthetic induction with the head in both the neutral position and a 45° rightward rotation. All patients benefited from the 45° head rotation, as reflected in significantly improved tidal volumes. The authors concluded that head rotation in the anesthetized, apneic adult increased the efficiency of mask ventilation and...