Comparison of nasal and face mask ventilation in anaesthetised obese adults: A randomised controlled study.

Abstract

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/m2. Ninety adult patients with BMI >25 kg/m2 were randomly assigned to receive either facemask (Group FM) or nasal-mask (Group NM) ventilation during induction of GA. Expired tidal volume (VtE), air leak, peak inspiratory pressure (PIP), plateau pressure (PPLAT), oxygen saturation (SpO2), and end-tidal carbon dioxide (EtCO2) were recorded for10 breaths, and their mean was analysed. The mean (standard deviation) VtE 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) cmH2O, P = 0.001, df: 88, mean difference, 95%CI: 5.15 (4.16, 6.14)], and mean PPLAT [12.04 (1.21) versus 16.66 (2.56) cmH2O, P = 0.001, df: 88, mean difference 95% CI: 4.62 (3.78, 5.45)] were significantly lower in Group NM. EtCO2, SpO2, and haemodynamic measurements were similar between the two groups. 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/m2.