• Yoshihiro Hirabayashi, Akifumi Fujita, and Hideharu Sugimoto.
• Department of Anesthesiology, International University of Health and Welfare Hospital, Nasushiobara 329-2763.
• Masui. 2013 Mar 1;62(3):337-40.

BackgroundEvery airway maneuver will cause some degree of neck movement. Ventilation via face-mask technique requires lifting the mandible (jaw thrust) to the facemask. A significant degree of cervical spine motion induced by bag-mask ventilation has been reported on human cadavers with destabilized cervical vertebrae. However, to our knowledge, no quantitative data have reported evaluating the effects of bag-mask ventilation on cervical spine motion in living humans. We measured the cervical spine movement during bag-mask ventilation.MethodsTwenty patients requiring general anesthesia were studied. Each patient underwent bag-mask ventilation. Movements of cervical spine were measured by radiography in the same patient both at neutral head position and during bag-mask ventilation.ResultsThe anterior movements of the vertebral bodies from baseline were 11.3 +/- 5.8 mm, 11.1 +/- 4.9 mm, 11.0 +/- 4.7 mm and 10.6 +/- 4.4 mm at the atlas, C2, C3, and C4 vertebrae, respectively, during bag-mask ventilation. The changes in angle during bag-mask ventilation were 7.4 +/- 4.5 degrees, 4.9 +/- 4.2 degrees, 1.7 +/- 3.2 degrees, and -0.1 +/- 2.3 degrees, at occiput/C1, C1/C2, C2/C3, and C3/C4 motion segments, respectively. The total change in angle between the occiput and C4 was 13.8 +/- 6.4 degrees (95% CI 10.9 degrees-16.8 degrees).ConclusionsThe lifting the mandible causes both extension and anterior disposition in the cervical vertebrae.

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