We aimed to evaluate if two-handed mask airway is superior to one-handedmask airway during inhalational induction of anesthesiain children.
A randomized, two period, crossover study was performed on 60 children aged 1 to 8 years, with obstructive sleep apnea due to adenotonsillar hypertrophy, scheduled for adenotonsillectomy. Children were assigned to two study sequences and one control sequence of 20 subjects each. A control sequence was added to evaluate the effect of anesthetic depth. Sequence 1: One-handed followed by two-handed airway, 30 seconds each; Sequence 2: two-handed followed by one-handedairway, 30 seconds each and Sequence 3: two-handedairway, for 60 seconds. The work of breathing indices, phase angle and labored breathing index were recorded using respiratory inductance plethysmography. Additional outcome measures were tidal volume, minute ventilation, and respiratory rate.A straight comparison and a crossover analysis was performed.
The initial comparison revealed that one-handed airway had greater phase angle (mean diff. 17.4; 95% confidence interval [CI] 1.07 to 33.68; p=0.034), greater labored breathing index (mean diff. 0.56; 95% CI 0.16 to 1.04; p=0.004),lower minute ventilation (mean diff. -1567; 95% CI -2695 to -5.4; p=0.004)and lower tidal volume (mean diff. -39; 95% CI -2.7 to -5.4; p=0.02) thantwo-handed airway. On crossover analysis, within-subject difference in the phase angle was greater during one-handedthan two-handed airway (34.3; 95% CI 8.46 to 60.14; p=0.01) as was labored breathing index (mean diff. 1.2; 95% CI 0.39 to 2.00; p<0.0046).Minute ventilation was lower during one-handed than two-handed airway (mean diff. -3359; 95% CI -4363 to -2355, p<0.0001) as was tidal volume(mean diff. -78; 95% CI -110.4 to -45.8; p<0.0001).
In children with obstructive sleep apnea due to adeno-tonsillar hypertrophy, two-handedairway provides superior airway patency that was not influenced by the anesthetic depth.

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