Head rotation, flexion, and extension alter endotracheal tube position in adults and children

Purpose The purpose of this study was to evaluate the effect of head rotation in adults and children on endotracheal tube (ETT) position and to confirm previous results regarding the influence of head flexion and extension on ETT position. Methods After inducing anesthesia in 24 young adults and 22 children (aged 1–9 yr), ETTs were secured on the right corner of each of their mouths. Using a fiberoptic bronchoscope, the distance from the carina to the tip of the ETT was measured with each patient’s head and neck placed in a neutral position, flexed, extended, rotated to the right, and rotated to the left. Results In all patients, flexing the head resulted in the ETT moving towards the carina, and extension resulted in the tube being displaced in the opposite direction. In adults, head rotation to the right resulted in withdrawal of the ETT in all but one patient; displacement was 0.8 ± 0.5 cm (mean ± SD) ( P