Isono S, Tanaka A, Tagaito Y, Sho Y, Nishino T
Department of Anesthesiology, Chiba University School of Medicine, Japan.
Anesthesiology. 1997 Nov;87(5):1055-62. doi: 10.1097/00000542-199711000-00008.
During anesthesia in humans, anterior displacement of the mandible is often helpful to relieve airway obstruction. However, it appears to be less useful in obese patients. The authors tested the possibility that obesity limits the effectiveness of the maneuver.
Total muscle paralysis was induced under general anesthesia in a group of obese persons (n = 9; body mass index, 32 +/- 3 kg[-2]) and in a group of nonobese persons (n = 9; body mas index, 21 +/- 2 kg[-2]). Nocturnal oximetry confirmed that none of them had sleep-disordered breathing. The cross-sectional area of the pharynx was measured endoscopically at different static airway pressures. A static pressure-area plot allowed assessment of the mechanical properties of the pharynx. The influence of mandibular advancement on airway patency was assessed by comparing the static pressure-area relation with and without the maneuver in obese and nonobese persons.
Mandibular advancement increased the retroglossal area at a given pharyngeal pressure, and mandibular advancement increased the retropalatal area in nonobese but not in obese persons at a given pharyngeal pressure.
Mandibular advancement did not improve the retropalatal airway in obese persons.
在人类麻醉期间，下颌骨向前移位通常有助于缓解气道梗阻。然而，在肥胖患者中似乎效果欠佳。作者测试了肥胖限制该操作有效性的可能性。
在全身麻醉下，对一组肥胖者（n = 9；体重指数，32±3 kg[-2]）和一组非肥胖者（n = 9；体重指数，21±2 kg[-2]）诱导完全肌肉麻痹。夜间血氧饱和度测定证实他们均无睡眠呼吸紊乱。在内窥镜下于不同静态气道压力下测量咽部横截面积。通过静态压力-面积图评估咽部的力学特性。通过比较肥胖者和非肥胖者在下颌前伸和未进行该操作时的静态压力-面积关系，评估下颌前伸对气道通畅性的影响。
在给定咽部压力下，下颌前伸增加了舌后区域的面积，并且在给定咽部压力下，下颌前伸增加了非肥胖者的腭后区域面积，但未增加肥胖者的腭后区域面积。
下颌前伸并未改善肥胖者的腭后气道。
