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The ventilation protocol flowchart followed in the study Standard face mask ventilation after induction ↓
Source publication
Background and Aims: Face mask ventilation of the edentulous patient is often difficult as ineffective seating of the standard mask to the face prevents attainment of an adequate air seal. The efficacy of nasal ventilation in edentulous patients has been cited in case reports but has never been investigated.
Material and Methods: Consecutive edentu...
Context in source publication
Context 1
... achieving best-fit positioning and allowing a minute to pass, the readings of the expired tidal volumes and adequacy of capnograph trace were noted. The ventilation strategy flowchart followed in the study is shown in Table 1. The SpO 2 , peak airway pressure, and fall in the bellows, in case any, were recorded. ...
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Despite progress in understanding the pathophysiology of acute lung damage, currently approved treatment possibilities are limited to lung-protective ventilation, prone positioning, and supportive interventions. Various pharmacological approaches have also been tested, with neuromuscular blockers and corticosteroids considered as the most promising...
Citations
... [13] On the contrary, nasal mask ventilation delivered a greater tidal volume in edentulous patients than face mask ventilation. [14] Facemask ventilation of edentulous patients is often inefficient due to a lack of facial support. Nasal mask ventilation may be more effective in these patients due to reduced air leaks and better contact with the maxillary plane. ...
... Similar results were demonstrated by Liang's study on the adult population, where nasal mask ventilation had significantly lower airway pressures than combined oral nasal mask ventilation (P < 0.05). [9] In contrast to our study, Kapoor et al. [14] found higher peak inspiratory pressures with nasal mask ventilation compared with face mask ventilation (P < 0.001). This finding may be attributed to small intraoral passage due to reduced maxillary height in edentulous patients. ...
Background and Aims
The use of a face mask while inducing general anaesthesia (GA) in obese patients is often ineffective in providing adequate ventilation. Although nasal mask ventilation has demonstrated effectiveness for continuous positive airway pressure (CPAP) in obese patients with obstructive sleep apnoea (OSA), it has not yet been applied to the induction of anaesthesia. This study evaluated the efficacy of nasal mask ventilation against standard face mask ventilation in anaesthetised obese patients with body mass index (BMI)>25 kg/m ² .
Methods
Ninety adult patients with BMI >25 kg/m ² were randomly assigned to receive either facemask (Group FM) or nasal-mask (Group NM) ventilation during induction of GA. Expired tidal volume (Vt E ), air leak, peak inspiratory pressure (PIP), plateau pressure (P PLAT ), oxygen saturation (SpO 2 ), and end-tidal carbon dioxide (EtCO 2 ) were recorded for10 breaths, and their mean was analysed.
Results
The mean (standard deviation) Vt E measured was not significantly higher in Group NM [455.98 (55.64) versus 436.90 (49.50) mL, P = 0.08, degree of freedom (df):88, mean difference (95% confidence interval [CI]) −19.08 (−41.14, 2.98) mL]. Mean air-leak [16.44 (22.16) versus 31.63 (21.56) mL, P = 0.001, df: 88, mean difference 95%CI: 15.19 (6.03,24.35)], mean PIP [14.79 (1.39) versus 19.94 (3.05) cmH 2 O, P = 0.001, df: 88, mean difference, 95%CI: 5.15 (4.16, 6.14)], and mean P PLAT [12.04 (1.21) versus 16.66 (2.56) cmH 2 O, P = 0.001, df: 88, mean difference 95% CI: 4.62 (3.78, 5.45)] were significantly lower in Group NM. EtCO 2, SpO 2 , and haemodynamic measurements were similar between the two groups.
Conclusion
Nasal mask ventilation is an effective ventilation method and can be used as an alternative to face mask ventilation in anaesthetised obese adults with BMI>25 kg/m ² .
... In elderly and edentulous patients, ventilation with the mask is one of the serious challenges due to the inadequate seal with air leaks, which is mainly due to the shrinking of the gums and facial tissues; this phenomenon makes it difficult to keep a mask without a leak ( Figure 1). Various methods have been proposed to facilitate the maintenance of the mask in these patients, including nasal ventilation, leaving dentures in, putting gauze inside the mouth in the buccal area or outside the mouth on the cheeks, or bilateral jaw thrust maneuver by one person with pulling of cheek around the mask and ventilation by another person (1)(2)(3)(4). ...
... In the nasal mask group, we did not use a traditional nasal mask because a disposable nasal mask oxygenation circuit at our hospital costs $60 compared with $6 for a nasal cannula. Based on the previous work in which an infant-size transparent anatomical facemask costing only $6 was used as a nasal oxygenation device to achieve effective ventilation, 11 we adopted an infant-sized transparent anatomical facemask as the nasal oxygenation device. We provided anesthetists 3 sizes of infant masks (6.5 × 6.5 cm, 8 × 6.7 cm, and 9.5 × 8 cm; Chongren Medical Instruments). ...
Background:
Hypoxemia can occur during gastroscopy under intravenous anesthesia. The aim of this randomized controlled trial was to evaluate whether oxygenation using a nasal mask can reduce the incidence of hypoxemia during gastroscopy under intravenous anesthesia compared with a traditional nasal cannula.
Methods:
A total of 574 patients scheduled for gastroscopy under intravenous anesthesia were enrolled and randomly assigned to receive either a nasal mask or a traditional nasal cannula for oxygenation. The primary outcome was the incidence of hypoxemia. The secondary outcomes included the incidence of severe hypoxemia, duration of hypoxemia, minimum oxygen saturation, the proportion of emergency airway management, length of procedure, recovery time, and the satisfaction of the anesthetist and gastroenterologists as well as other adverse events (including cough, hiccups, nausea and vomiting, reflux, aspiration, and laryngospasm).
Results:
A total of 565 patients were included in the analysis: 282 patients in the nasal cannula group and 283 patients in the nasal mask group. The incidence of hypoxemia was lower in the nasal mask group (18.0%) than in the nasal cannula group (27.7%; relative risk [RR] = 0.65; 95% confidence interval [CI], 0.48-0.89; P = .006), and the hypoxemia lasted a median of 18.0 seconds (interquartile range, 10.0-38.8) in the nasal mask group and 32.5 seconds (20.0-53.5) in the nasal cannula group (median difference -14.50; 95% CI, -22.82 to -1.34; P = .047). The proportion of patients requiring emergency airway management was significantly lower in the nasal mask group (8.8%) than in the nasal cannula group (19.1%; RR, 0.46; 95% CI, 0.30-0.73; P < .001). No difference was found in the overall incidence of other adverse events between the 2 groups (nasal mask 20.8%; nasal cannula 17.0%; RR, 1.23; 95% CI, 0.87-1.73; P = .25). Satisfaction was higher with the nasal mask than with the nasal cannula from the perspective of anesthetists (96.1% for nasal mask versus 84.4% for nasal cannula; RR, 1.14; 95% CI, 1.08-1.20; P < .001) and gastroenterologists (95.4% for mask versus 81.9% for cannula; RR, 1.17; 95% CI, 1.10-1.24; P < .001). There were no significant differences in the incidence of severe hypoxemia, minimum oxygen saturation, length of procedure, or recovery time between the 2 groups.
Conclusions:
Nasal mask oxygenation reduced the incidence of hypoxemia during anesthesia for gastroscopy under intravenous anesthesia.
... However, this may be compromised in patients with obesity or obstructive sleep apnea (OSA) due to partial or complete pharyngeal obstruction. [1][2][3] In patients with facial trauma, craniomaxillofacial anomalies, or presence of external hardware, it may not be possible to achieve an adequate mask seal or perform bagmask-ventilation with a conventional facemask. 4,5 For these pa-tients and others with confirmed or suspected difficult airways, management alternatives including nasal ventilation may be more appropriate. ...
... Patients who are obese, pregnant, suffer from chronic OSA, and/or pediatric cases may be at higher risk for this complication. [1][2][3] Similarly, for patients with craniomaxillofacial dysmorphology or trauma, anesthesiologists may be unable to achieve an adequate seal with a conventional facemask, 4,9,10 placing the patient at greater risk for desaturation due to inadequate ability to bag-mask-ventilate and intubate. ...
... Moreover, nasal mask ventilation has been reported to give better air delivery and to have a reduced risk of leaks; however, this method can cause oral air leakage. 7 We suggest use of a new mask support device consisting of a soft cotton cloth pad of square shape with breadth of 2 inches and a circular aperture in the center (Fig. 1). This cotton pad is placed so as to cover the patient's mouth and nostrils, with the central hole over the nostrils. ...
Introduction: Bag-valve-mask (BVM) ventilation is the first and important part of the airway management. The aim of present study was to evaluate the quality of four different BVM ventilation techniques – E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (Non dominant hand), and Thenar Eminence (Non dominant hand)-E-C (Dominant hand) – among two novice and experienced groups.
Methods: In a case-control and mannequin based study that was conducted in Tabriz University of medical sciences, 120 volunteers were recruited and divided into two groups. 60 participants in experienced and other 60 as novice group who observed BVM ventilation but hadn’t practical experience about BVM ventilation. Every participant in both groups performed 4 BVM ventilation techniques under the supervision of an experienced assessor. Quality of mannequin chest expansion was recorded by two other experienced assessors who were blind to ventilation process. The data were analyzed with SPSS 17.0.
Results: In novice group, when evaluating each technique performance, they did Thenar Eminence (non-dominant hand) - E-C (dominant hand) technique much better than the others (P<0.0001). But in the experienced group, there was no meaningful difference between the all four techniques (P= 0.102).
Conclusion: Novice participants did Thenar Eminence (non-dominant hand) - E-C (dominant hand) technique better than the others. Therefore, it is recommended that training of this technique was placed in educational program of medical students.
