Objective: Continuous maintenance of an appropriate position of the mandible and head purely by manual manipulation is difficult, although the maneuver can restore airway patency during sleep and anesthesia. The aim of this study was to examine the effect of head elevation with jaw closure using a remote-controlled airbag device, such as the airbag system, on passive upper
airway collapsibility during propofol anesthesia.
Method: Seven male subjects were studied. Propofol infusion was used for anesthesia induction and maintenance, with a target blood propofol concentration of 1.5 to 2.0 µg/ml. Nasal mask pressure (PN) was intermittently reduced to evaluate upper airway collapsibility (passive PCRIT) and upstream resistance (RUS) at three different head and jaw positions, jaw opening position in the supine position, jaw opening position in the sniffing position with 6 cm head elevation, and jaw closure at a 6 cm height sniffing position. The 6 cm height sniffing position with jaw closure was achieved by an airbag device that was attached to the subjects’ head like headgear. Patient demographics, PCRIT and RUS in each condition were compared using one-way ANOVA with a post hoc Turkey test. P <0.05 was considered significant. We have also tried to confirm the effects of our airbag device on improvement of upper airway collapsibility in three obstructive sleep apnea patients under clinical study.
Results: The combination of 6 cm head elevation with jaw closure using the air-inflatable robot airbag system decreased upper airway collapsibility (PCRIT ~ -3.4 cmH2O) compared to the baseline position (PCRIT ~ -0.8 cmH2O, P=0.0001). In clinical study, there was improvement of upper airway obstruction in OSA patients associated with a decreased apnea and hypopnea duration and an increased lowest level of oxygen saturation.
Conclusion: We demonstrated that establishment of head elevation with jaw closure achieved by a remote-controlled airbag device using an inflatable airbag system can produce substantial decreases in upper airway collapsibility and maintain upper airway patency during propofol anesthesia and sleep.
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