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4 results

  • Total nasal airway resistance while sitting predicts airway collapse when lying down

  • A Karlsson, M Persson, A-C Mjörnheim, G Gudnadottir, J Hellgren
  • Journal:
    The Journal of Laryngology & Otology / Volume 134 / Issue 10 / October 2020
    Published online by Cambridge University Press:
    27 October 2020, pp. 917-924
    Print publication:
    October 2020
  • Background

    Nasal obstruction when lying down is a common complaint in patients with chronic nasal obstruction, but rhinomanometry is typically performed in the sitting position. This study aimed to analyse whether adding rhinomanometry in a supine position is a useful examination.

    Method

    A total of 41 patients with chronic nasal obstruction underwent rhinomanometry and acoustic rhinometry, sitting and supine, before and after decongestion, as well as an over-night polygraphy.

    Results

    Total airway resistance was measurable in a supine position in 48 per cent (14 of 29) of the patients with total airway resistance of equal to or less than 0.3 Pa/cm3/second when sitting and in none (0 of 12) of the patients with total nasal airway resistance of more than 0.3 Pa/cm3/second when sitting. After decongestion, this increased to 83 per cent and 58 per cent, respectively.

    Conclusion

    Increased nasal resistance when sitting predicts nasal breathing problems when supine. Rhinomanometry in a supine position should be performed to diagnose upper airway collapse when supine.

  • Airway changes in obstructive sleep apnoea patients associated with a supine versus an upright position examined using cone beam computed tomography

  • M Camacho, R Capasso, S Schendel
  • Journal:
    The Journal of Laryngology & Otology / Volume 128 / Issue 9 / September 2014
    Published online by Cambridge University Press:
    27 August 2014, pp. 824-830
    Print publication:
    September 2014
  • Objective:

    This study aimed to describe total volume and cross-sectional area measurement changes in obstructive sleep apnoea patients associated with a supine versus an upright position.

    Method:

    A retrospective chart review of patients who underwent cone beam computed tomography in upright and supine positions was performed, and the images were analysed.

    Results:

    Five obstructive sleep apnoea patients (all male) underwent both upright and supine cone beam computed tomography imaging. Mean age was 35.0 ± 9.3 years, mean body mass index was 28.1 ± 2.7 kg/m2 and mean apnoea–hypopnoea index was 39.3 ± 23.0 per hour. The airway was smaller when patients were in a supine compared with an upright position, as reflected by decreases in the following airway measurements: total volume; posterior nasal spine, uvula tip, retrolingual and tongue base (not significant) cross-sectional areas; and site of the minimum cross-sectional area (of the overall airway). Total airway volume decreased by 32.6 per cent and cross-sectional area measurements decreased between 32.3 and 75.9 per cent when patients were in a supine position.

    Conclusion:

    In this case series, the airway of obstructive sleep apnoea patients was significantly smaller when patients were in a supine compared with an upright position.

  • 19 - Nursing considerations

  • from Section 4 - Post-operative conditions
  • Edited by Adrian Alvarez, Jay B. Brodsky, Stanford University School of Medicine, California, Hendrikus J. M. Lemmens, Stanford University School of Medicine, California, John M. Morton, Stanford University School of Medicine, California
  • Book:
    Morbid Obesity
    Published online:
    04 May 2010
    Print publication:
    11 March 2010, pp -

  • Summary

    Intra-operative positioning considerations are more important for the obese patient. The supine position causes a marked increase in intra-abdominal pressure, which results in a splinting effect of abdominal contents on the diaphragm. Awake, spontaneously breathing obese patients should be in a head-up position. The Trendelenburg position can be used to engorge neck veins to facilitate central venous cannulation. Spontaneously breathing obese patients generally do not tolerate the Trendelenburg position. In mild to moderately obese patients, respiratory mechanics, lung volumes, and oxygenation all increase when changing from the supine to prone position. Due to the difficulties moving and positioning mobidly obese (MO) patients, procedures routinely performed prone are often done in the lateral decubitus position. In the lithotomy position the patient is on their back with their legs and thighs flexed at right angles. MO patients are at special risk for rhabdomyolysis (RML), a potentially fatal post-operative complication.