Effect of Head Rotation on Efficiency of Face Mask Ventilation among Apnoeic Patients: A Cross-sectional Study

Abstract

Introduction: Respiratory function is crucial in the practice of anaesthesia. An in depth understanding of respiratory physiology is a must because it aids in the proper execution of daily general anaesthesia practice. Head and body postures have long been known to affect the patency of the upper airway. Head extension and a lateral recumbent position help to clear the upper airway. Head rotation is known to expand the upper airway’s cross-sectional area. Aim: To determine the effect of head rotation on efficiency of face mask ventilation among apnoeic patients, by measuring expiratory tidal volume. Materials and Methods: This cross-sectional study was conducted in the Department of Anaesthesiology at Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India, from May 2021 to November 2021. Total 40 patients belonging to the age group of 20 to 40 years, American Society of Anaesthesiologists’ (ASA) class I and II, undergoing surgeries requiring general anaesthesia with endotracheal intubation, were selected as study subjects. They were administered inj. fentanyl at a dose of 1 to 2 μg/kg, inj.propofol at a dose of 1 to 2 mg/kg, and inj.vecuronium bromide (0.08 to 0.1 mg/kg). Patients were mask ventilated with pressurecontrolled ventilation, for a total of 3 minutes, during which they were ventilated in a neutral head position for 90 seconds and then rotated for another 90 seconds. Following induction, the expiratory tidal volume was measured every 30 seconds in both postures Software used was Statistical Package for Social Sciences for windows (SPSS Inc., Chicago, IL, USA), version 17.0. A p-value <0.05 was considered statistically significant. Results: The mean age of patients was 48±8.3 years. The 45° head rotation was beneficial to all patients, the mean expiratory tidal volume was 423±62.5 mL in the rotated head position compared to 397±52.5 mL in the neutral head position (p-value=0.045). It was also observed that some individuals profited more than others. Patients with airway obstruction, for example, had a greater VTE at 45° head rotation than in a neutral head position. Conclusion: The most notable conclusion is that in apnoeic adult patients, a 45° head rotation showed a significant enhancement in VTE when compared to a neutral position ofthe head.