Opening the upper airway - Airway maneuvers in pediatric anesthesia

We conclude that jaw thrust is the most effective maneuver to open an obstructed airway and improve ventilation in anesthetized and unconscious spontaneously breathing pediatric patients. Whereas chin lift is effective in healthy children without tonsillar hypertrophy, it has the potential to obstruct the airway in children with hypertrophic tonsils and adenoids when the mouth is closed. Given the high incidence of large tonsils and adenoids especially in toddlers and preschool children, chin lift is a less reliable measure to improve upper airway patency in this age group. CPAP with or without jaw thrust and chin lift can further improve upper airway patency in sedated or anesthetized children, but may decrease ventilation in some patients.