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A two-handed jaw-thrust technique is superior to the one-handed "EC-clamp" technique for mask ventilation in the apneic unconscious person.

Abstract：

BACKGROUND:Mask ventilation is considered a "basic" skill for airway management. A one-handed "EC-clamp" technique is most often used after induction of anesthesia with a two-handed jaw-thrust technique reserved for difficult cases. Our aim was to directly compare both techniques with the primary outcome of air exchange in the lungs. METHODS:Forty-two elective surgical patients were mask-ventilated after induction of anesthesia by using a one-handed "EC-clamp" technique and a two-handed jaw-thrust technique during pressure-control ventilation in randomized, crossover fashion. When unresponsive to a jaw thrust, expired tidal volumes were recorded from the expiratory limb of the anesthesia machine each for five consecutive breaths. Inadequate mask ventilation and dead-space ventilation were defined as an average tidal volume less than 4 ml/kg predicted body weight or less than 150 ml/breath, respectively. Differences in minute ventilation and tidal volume between techniques were assessed with the use of a mixed-effects model. RESULTS:Patients were (mean ± SD) 56 ± 18 yr old with a body mass index of 30 ± 7.1 kg/m. Minute ventilation was 6.32 ± 3.24 l/min with one hand and 7.95 ± 2.70 l/min with two hands. The tidal volume was 6.80 ± 3.10 ml/kg predicted body weight with one hand and 8.60 ± 2.31 ml/kg predicted body weight with two hands. Improvement with two hands was independent of the order used. Inadequate or dead-space ventilation occurred more frequently during use of the one-handed compared with the two-handed technique (14 vs. 5%; P = 0.013). CONCLUSION:A two-handed jaw-thrust mask technique improves upper airway patency as measured by greater tidal volumes during pressure-controlled ventilation than a one-handed "EC-clamp" technique in the unconscious apneic person.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Joffe AM,Hetzel S,Liew EC

doi

10.1097/ALN.0b013e3181ec6414

subject

Has Abstract

pub_date

2010-10-01 00:00:00

pages

873-9

issue

eissn

0003-3022

issn

1528-1175

journal_volume

113

pub_type

杂志文章,随机对照试验

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A two-handed jaw-thrust technique is superior to the one-handed "EC-clamp" technique for mask ventilation in the apneic unconscious person.