Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-28T04:22:37.644Z Has data issue: false hasContentIssue false

Endotracheal tube positioning during neck extension in thyroidectomy

Published online by Cambridge University Press:  07 September 2015

S D Sharma*
Affiliation:
Department of Otorhinolaryngology, Queens Hospital, Romford, UK
G Kumar
Affiliation:
Department of Otorhinolaryngology, Queens Hospital, Romford, UK
H Kanona
Affiliation:
Department of Otorhinolaryngology, Queens Hospital, Romford, UK
T Jovaisa
Affiliation:
Department of Otorhinolaryngology, Queens Hospital, Romford, UK
H Kaddour
Affiliation:
Department of Otorhinolaryngology, Queens Hospital, Romford, UK
*
Address for correspondence: Mr Sunil Dutt Sharma, Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford RM7 0AG, UK Fax: +44 1708 435096 E-mail: [email protected]

Abstract

Objective:

To evaluate the effect of body mass index and neck length on endotracheal tube movement during neck extension in thyroidectomy.

Methods:

A prospective study was conducted of 30 patients undergoing thyroidectomy during an 8-month period. Patient characteristics were recorded and endotracheal tube displacement was determined.

Results:

Mean body mass index was 27.8 kg/m2 (range, 17.5–34.7 kg/m2) and mean neck circumference was 43.2 cm (range, 28–56 cm). The mean (± standard deviation) upward displacement of the endotracheal tube during neck extension was 7.17 ± 5.87 mm. Patients with a larger body mass index had a significantly greater amount of tube displacement (R2 = 0.67, p < 0.0001), as did patients with a smaller neck length (R2 = 0.48, p < 0.0001).

Conclusion:

Neck extension results in upward displacement of the endotracheal tube. The amount of displacement is significantly higher in patients with a larger body mass index or shorter neck length. This has particular relevance for nerve monitoring in thyroidectomy.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at the American Academy of Otolaryngology – Head and Neck Surgery Annual Meeting, 21 September 2014, Orlando, Florida, USA.

References

1British Association of Endocrine and Thyroid Surgeons. Fourth National Audit Report, 2012. In: http://www.baets.org.uk/wp-content/uploads/2013/05/4th-National-Audit.pdf [13 August 2014]Google Scholar
2Mihai, R, Randolph, GW.Thyroid surgery, voice and the laryngeal examination – time for increased awareness and accurate evaluation. World J Endocrine Surg 2009;1:15CrossRefGoogle Scholar
3NHS Litigation Authority. Factsheet 3: Information on claims, 2013-14. In: http://www.nhsla.com/currentactivity/Documents/NHS%20LA%20Factsheet%203%20-%20claims%20information%202013-14.pdf [13 July 2015]Google Scholar
4National Institute for Health and Clinical Excellence. IPG255: Intraoperative nerve monitoring during thyroid surgery, March 2008. In: http://www.nice.org.uk/proxy/?sourceUrl=http://%3A%2F%2Fwww.nice.org.uk%2Fnicemedia%2Flive%2F11872%2F40081%2F40081.pdf [11 July 2015]Google Scholar
5GraphPad. QuikCalcs: Linear regression calculator. In: http://www.graphpad.com/quickcalcs/linear1/ [13 August 2014]Google Scholar
6Conrardy, PA, Goodman, LR, Lainge, F, Singer, MM.Alteration of endotracheal tube position. Flexion and extension of the neck. Crit Care Med 1976;4:712CrossRefGoogle ScholarPubMed
7Sugiyama, K, Yokoyama, K.Displacement of the endotracheal tube caused by change in head position in paediatric anaesthesia: evaluation by fibreoptic bronchoscopy. Anesth Analg 1996;82:251–3Google Scholar
8Yap, SJ, Morris, RW, Pybus, DA.Alterations in endotracheal tube position during general anaesthesia. Anaesth Intensive Care 1994;22:586–8CrossRefGoogle ScholarPubMed
9Hartrey, R, Kestin, IG.Movement of oral and nasal tracheal tubes as a result of changes in head and neck position. Anaesthesia 1995;50:682–7CrossRefGoogle ScholarPubMed
10Kim, J-T, Kim, H-J, Ahn, W, Kim, H-S, Bahk, J-H, Lee, S-C et al. Head rotation, flexion, and extension alter endotracheal tube position in adults and children. Can J Anaesth 2009;56:751–6CrossRefGoogle ScholarPubMed