Abstract
Traditionally, there are two main methods of mask placement during face mask ventilation: one handed (CE) grip and two handed grip (THT). One handed grip is limited by air leaks between mask and patients face on the side opposite to stabilizing hand. Two handed grips provide protection against air leak but require second provider to deliver tidal volumes when using a self inflating bag or anesthesia circuit on manual ventilation. This study introduces modified CE grip which creates a firm seal at patient’s face on both sides of mask, enabling adequate tidal volume delivery with provider’s second hand. Using left hand, provider places the fifth digit along inferior border of body of left mandible. The fourth digit is placed along inferior border of body right mandible. Standing 6 inches to the left and immediately behind a supine patient on an OR table, provider rotates clockwise 45 degrees at hip, keeping elbow against their body, and lifts patient’s chin to 45 degrees. Rotational force at hip augments hand strength while tilting chin. The thumb applies pressure along left border of facemask, and the second and third digits apply pressure to right border of facemask. Methods: Patients with known predictors of difficult mask ventilation (Edentulous, bearded, Obstructive sleep apnea (OSA), mallampati 3 or 4) were in experimental group. Normal patients assigned as Controls. After induction of general anesthesia, provider ventilated patient using adult sized facemask. The anesthesia ventilator delivered standardized tidal volumes. TV, airway pressures, HR and O2 saturation were recorded after each breath. Results: All groups, except OSA, showed improvement, in tidal volumes with the novel technique compared to the traditional CE grip. Conclusion: The novel submandibular technique, an important skill, increases tidal volumes during mask ventilation for certain high risk patients.
Highlights
A vital technique that should be mastered by virtually all medical personnel, has the capacity to save lives in acute care settings, in remote field situations, and in procedures performed with sedation [1]
Advances in mask ventilation technique that allow it to be performed with greater success for a wider range of patients may have a profound impact on morbidity and mortality
Power analysis was not performed as our primary aim was to determine if the novel submandibular technique (NST) was capable of delivering tidal volumes in high risk patients
Summary
A vital technique that should be mastered by virtually all medical personnel, has the capacity to save lives in acute care settings, in remote field situations, and in procedures performed with sedation [1]. The study of predictors of difficult mask ventilation (DMV) began with Langeron et al, who defined DMV as “the inability of an unassisted anesthesiologist to maintain the measured oxygen saturation as measured by pulse oximetry > 92% or to prevent or reverse signs of inadequate ventilation during positive-pressure mask ventilation under general anesthesia”. They found that the incidence of DMV was approximately 5% [4]. This study proposes a novel sub-mandibular one-handed grip that allows a sole provider to apply pressure on the left and right borders of the facemask during mask ventilation (Figure 3 and Figure 4)
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