{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T17:42:04Z","timestamp":1783359724126,"version":"3.54.6"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,5,24]],"date-time":"2020-05-24T00:00:00Z","timestamp":1590278400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,5,24]],"date-time":"2020-05-24T00:00:00Z","timestamp":1590278400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The classic formula has been used to estimate the depth of tracheal tube intubation in children for decades. However, it is unclear whether this formula is applicable when the head and neck position changes intraoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively reviewed the data of 172 well-developed children aged 2\u201312\u2009years (64.0% boys) who underwent head and neck surgery under general anesthesia. The distances from the tracheal carina to the endotracheal tube tip (CT), from the superior margin of the endotracheal tube tip to the vocal cord posterior commissure (CV), and from the tracheal carina to the posterior vocal commissure (TV) were measured in the sniffing position (maximum), neutral head, and maximal head flexion positions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Average CT and CV in the neutral head position were 4.33\u2009cm and 10.4\u2009cm, respectively. They increased to 5.43\u2009cm and 11.3\u2009cm, respectively, in the sniffing position, and to 3.39\u2009cm and 9.59\u2009cm, respectively, in the maximal flexion position (all<jats:italic>P<\/jats:italic>-values &lt;\u20090.001). TV remained unchanged and was only dependent on age. After stratifying patients by age, similar results were observed with other distances. CT and CV increased by 1.099\u2009cm and 0.909\u2009cm, respectively, when head position changed from neutral head to sniffing position, and decreased by 0.947\u2009cm and 0.838\u2009cm, respectively, when head position changed from neutral head to maximal flexion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Change in head position can influence the depth of tracheal tube intubation. Therefore, the estimated depth should be corrected according to the surgical head position.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12871-020-01033-7","type":"journal-article","created":{"date-parts":[[2020,5,24]],"date-time":"2020-05-24T10:02:33Z","timestamp":1590314553000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of changes in head position during head and neck surgery on the depth of tracheal tube intubation in anesthetized children"],"prefix":"10.1186","volume":"20","author":[{"given":"Siyi","family":"Yan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,5,24]]},"reference":[{"issue":"2","key":"1033_CR1","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/S0196-0644(82)80328-4","volume":"11","author":"S Dronen","year":"1982","unstructured":"Dronen S, Chadwick O, Nowak R. 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