Mask Ventilation Research Articles

Impact of Operating Table Height on the Difficulty of Mask Ventilation and Laryngoscopic View.

Background/Objectives: Airway management techniques, including mask ventilation and tracheal intubation, are vital across medical settings. However, these procedures can be challenging, especially when environmental conditions are less than ideal. This study explores how the height of the operating table affects the difficulty of anesthesia techniques involving mask ventilation and tracheal intubation. Methods: Twenty anesthesiologists participated in this study. We assessed the difficulty of procedures such as mask ventilation, Macintosh laryngoscopy, and video laryngoscopy using McGRATH and AWS, on a four-level scale. The operating table's height was adjusted at four points: the operator's umbilicus, the inferior margin of the 12th rib, the xiphoid process, and the nipple. Results: Mask ventilation was easiest at the operating table's height aligned with the inferior margin of the 12th rib. Conversely, direct laryngoscopic exposure was perceived as easier at higher table heights, with nipple height being optimal. The McGRATH laryngoscopy showed consistent difficulty across table heights, whereas the AWS tended to be somewhat more difficult at greater heights. Conclusions: The optimal bed height for video laryngoscopy coincided with that for mask ventilation. Video laryngoscopy offers enhanced flexibility in optimal patient positioning compared to Macintosh laryngoscopy, contributing to its advantages in tracheal intubation procedures.

An Innovative Technique to Prevent Air Leaks from Cervical Esophagostomy during Face Mask Ventilation.

The objective of the study was to report the indigenous use of an electrocardiography (ECG) electrode in successfully occluding the Cx-esophagostomy to prevent inadvertent loss of tidal volume. Twenty-nine observations were recorded on 27 patients (mean age: 10.9 months; male:female = 2.6:1). The oral cavity, pharynx, and Cx-esophagostomy were cleared of saliva. Peristomal area was cleaned with dry gauze and dried with alcohol. Latex-free, 50 mm, ECG electrode was pasted symmetrically over the Cx-esophagostomy. The efficacy of the electrode was assessed using a five-point algorithm: (i) collapse of reservoir bag, (ii) chest expansion, (iii) ballooning of electrode, (iv) cotton-wisp test, and (v) change in compliance with manual compression of the electrode. Subgroup analysis was conducted for laterality and health of Cx-esophagostomy. Study cohort: Cx-esophagostomy was located on the left in 58.26% (n = 17/29) patients. The health of Cx-esophagostomies was graded from I to IV (n = 9, 16, 3, and 1, respectively). The collapse of the reservoir bag and chest rise indicated successful ventilation. Ballooning of the electrode with each breath was observed in 79% (23/29) patients. Partial separation of the electrode from the skin (exaggerated with each breath) was observed in 10.3% (3/29) patients (Group I: n = 1, Group III: n = 1, and Group IV: n = 1). This was related to poor local preparation or pooling of saliva (n = 1; Group I: resolved with procedural re-application of a fresh electrode) and underlying skin condition (n = 2; Groups III and IV: resolved only temporarily with re-application). The cotton-wisp test was positive in two additional patients (1 each in Groups II and III) and was related to the pooling of saliva. No change in compliance was observed with manual compression of the electrode. No difference in success was observed between left and right Cx-esophagostomies. Overall success with this technique was 82.8% with a potential for 100% in those with peristomal health graded I-III. The ECG electrode is a technically simple, cost-effective, and widely available device, instrumental in addressing the problem of air leak through Cx-esophagostomy during face mask ventilation before intubation.

Correlation of cardiotocography with combined APGAR scores and diagnostic performance of umbilical cord parameters in predicting low combined APGAR scores – A prospective Cohort study

ObjectivesCombined Apgar score includes utilization of interventions such as Continuous positive airway pressure, Oxygen, Mask and Bag ventilation, I ntubation and ventilation, Ne onatal chest compression, Drugs, and newborn assessment. It has been proposed as a substitute for conventional Apgar score which is the gold standard for evaluating newborns right after birth but is impacted by medical interventions and preterm. Combined Apgar scores were examined to check for correlation with CTG tracing and umbilical cord blood parameters which gives an objective assessment of fetal hypoxia, in response to the demand for a more accurate tool for evaluating the neonate and to be used for medico-legal purposes. The study's objectives were to (1) determine the association of combined Apgar scores with suspicious and pathological CTG (2) the association of umbilical cord parameters with low combined Apgar scores and the diagnostic performance of these parameters in predicting low combined Apgar scores. Study designA prospective observational cohort study was conducted in a tertiary care center in East India. 2350 consecutive laboring mothers who had completed 34 weeks of gestation underwent cardiotocography according to institutional protocol and those with suspicious and pathological CTG who delivered within 1 h of abnormal CTG were recruited. Arterial blood was analyzed and the newborn was evaluated immediately after delivery with a combined Apgar scoring system ResultsOf the 2350 women, 50.7 % and 49.3 %, respectively, exhibited suspicious and abnormal CTG tracings. CTG was reported to have low diagnostic accuracy and specificity, with a sensitivity of 66.7 % and 88.9 %, respectively, in detecting combined Apgar at 1 and 5 min. The combined Apgar score at five minutes showed a strong association with acidosis. There was a statistically significant correlation between low combined Apgar and excess lactate and base at one and five minutes. With 100 % sensitivity and 95 % specificity, high lactate levels > 4.1 mM/L were found to predict newborn encephalopathy. ConclusionUmbilical cord blood parameters were found to be correlated with low combined Apgar scores. Combined Apgar scores may be a more useful tool for neonatal assessment and long-term morbidity of newborns. Additional research is required to determine whether it can take the role of conventional Apgar scores in clinical practice.

DIFFICULT MASK VENTILATION IN OBESE PATIENTS: ANALYSIS OF PREDICTIVE FACTOR

American Society of Anesthesiologists (ASA), DMV is defined as the clinical situation. developing when it not possible for the anesthesiologist to provide adequate ventilation because of one or more of the following problems: inadequate mask seal, excessive gas lead or excessive resistance to the ingress or egress of gas. Materials and Methods:-This is a prospective randomised observational study in patients with morbid obesity (n = 90body mass index[BMI] >30 kg/m2. Patients were preoperatively assessed for age, height, weight, BMI,modified Mallampati test results,mouth opening [inter- incisor gap (cm)], thyromental distance (cm), sternomental distance (cm), mandibular protrusion,mandibular length (ML), neck circumference (NC) by anesthesiologist. Mask ventilation was graded according to four point Han scale. Conclusion:In conclusion, male sex, snoring history, NC ≥43 cm, ML ≥9 cm and NC/TMD <5 cm were correlated with DMV in obese patients.According to the current investigation the three predictive factors are strongly associated.In the present study we demonstrated that (a)age >49 years, (B)Neck circumference >43cm,and (C) and short neck are strongly associated with DMV in obese patients.

Comparative Evaluation of Effectiveness of Two-handed E-C Clamp Technique versus V-E Technique in Patients with Predicted Difficult Mask Ventilation

Abstract Background: The skill of bag mask ventilation (BMV) remains pivotal during airway management for maintenance of oxygenation in apneic unconscious patients. Two-handed BMV techniques viz., the traditional E-C and V-E have been proven to be superior to one-handed techniques in optimizing BMV in difficult mask ventilation (DMV) scenarios. Aims and Objectives: This study aimed to compare the effectiveness of these two techniques of BMV in adult patients with predicted DMV. Methods: Four hundred ASA I-III adult patients with predictors of DMV received BMV after induction of anaesthesia using E-C clamp and V-E techniques in a randomized cross-over manner. Ventilator was set to VCV mode delivering tidal volume of 7 ml/kg, respiratory rate of 10 breaths per minute, and no PEEP. The primary outcome was exhaled tidal volume (Vte) and secondary outcomes analysed included air-leak, peak inspiratory pressure (PIP), end-tidal carbon dioxide (EtCO2), minute ventilation (MV), plateau pressure and SpO2. Results: Two-handed V-E technique generated significantly higher mean Vte of 377.83 ± 58.43 ml as compared to two-handed E-C technique (303.26 ± 103.34 ml). The air-leak was found to be significantly more with E-C technique (131.05 ml ± 100.95 ml) as compared to V-E technique (59.08 ± 49.62 ml). Higher EtCO2, MV with concomitant lower airway pressures were observed with V-E technique. Failure rate of BMV was significantly higher with E-C technique (19%) as compared to V-E technique (1%) (P = 0.001). Conclusion: Two-handed V-E technique results in more effective ventilation as compared to two-handed E-C technique in patients with predictors of difficult BMV. This technique may be preferred as a first option in patients with anticipated DMV.

Colorimetric CO2 Detector to Improve Effective Mask Ventilations in Very Preterm Infants: A Pilot Randomized Controlled Study

Introduction: End-tidal CO2 (ETCO2) detector is currently recommended for confirmation of endotracheal tube placement during neonatal resuscitation. Whether it is feasible to use ETCO2 detectors during mask ventilation to reduce risk of bradycardia and desaturations, which are associated with increased risk of death in preterm babies, is unknown. Methods: This is a pilot randomized controlled trial (NCT04287907) involving newborns 24 + 0/7 to 32 + 0/7 weeks gestation who required mask ventilation at birth. Infants were randomized into groups with or without colorimetric ETCO2 detectors. Combined duration of any bradycardia (<100 bpm) and time below prespecified target oxygen saturation (SpO2) as measured by pulse oximetry were compared. Results: Fifty participants were randomized, 47 with outcomes analysed (2 incomplete data, 1 postnatal diagnosis of trachea-oesophageal fistula). Mean gestational age and birthweight were 28.5 ± 1.9 versus 29.4 ± 1.6 weeks (p = 0.1) and 1,252.7 ± 409.7 g versus 1,334.6 ± 369.1 g (p = 0.5) in the intervention and control arm, respectively. Mean combined duration of bradycardia and desaturation was 276.7 ± 197.7 s (intervention) and 322.7 ± 277.7 s (control) (p = 0.6). Proportion of participants with any bradycardia or desaturation at 5 min were 38.1% (intervention) and 56.5% (control) (p = 0.2). No chest compressions, epinephrine administration, or death occurred in the delivery room. Conclusion: This pilot study demonstrates the feasibility of a trial to evaluate colorimetric ETCO2 detectors during mask ventilation of very preterm infants to reduce bradycardia and low SpO2. Further assessment with a larger population will be required to determine if ETCO2 detector usage at resuscitation reduces risk of adverse outcomes, including death and disability, in very preterm infants.

Difficult mask ventilation: An objective criterion

Effective mask ventilation plays a critical role in safe management of airway before intubation or after failed intubation. Mask ventilation (MV) is the primary technique of ventilation before tracheal intubation or insertion of any airway device. Its most unique role however, is as a rescue technique for ventilation should tracheal intubation fail or prove difficult. The ability to establish adequate MV has, therefore, become a major branch point in any difficult airway algorithm. Despite it being an important skill, MV has received little attention in the extensive body of literature and book chapters addressing airway management when compared to laryngoscopy and intubation. At present, there is no standard definition for Difficult Mask Ventilation (DMV) that is based on precise and objective criterion. The authors propose a simple objective criterion to categorize difficult mask ventilation based on the best monitoring parameters.

Comparison of The Effectiveness of E-C Positive Pressure Ventilation Technique and Modified Chinlift Positive Pressure Ventilation Technique in Mppd at Ibnu Sina Hospital

Mask ventilation skills are essential competencies for MPPD to master. According to SKDI, these skills include competency 4A, which is the ability to perform independently by mastering the theory, principles, indications, and steps. To date, there have been few studies evaluating the effectiveness of modified chinlift and E-C techniques regarding the tidal volume delivered (TV). Therefore, the researchers were interested in comparing the effectiveness of the E-C method and modified chinlift positive pressure ventilation technique in mask ventilation (MV) use. This study is a quantitative research with an observational analytical cross-sectional design. Researchers observed the treatments given by MPPD, totaling 22 individuals, to 6 research subjects. Data analysis for this research used Mann-Whitney and chi-square tests as Independence Tests. After applying the E-C technique, 43.8% out of 100% were successful, and 56.3% were not successful. Meanwhile, with the MCL technique, out of 100%, 40.6% were successful, and 59.4% were not successful. The E-C technique showed better results compared to the Modified Chinlift technique in MV, although statistically, the test results for the difference in success scores between the two techniques did not show any significant difference.

Feasibility of ProVu™ Video Stylet for awake intubation of patients with severe obesity: A pilot observational study

BackgroundAirway management in the obese patient is known to be challenging as oxygenation may rapidly decrease after general anesthesia induction. Mask ventilation and tracheal intubation can be complicated due to obesity-related anatomical features. The reduced safe apnea time can put the patient at risk of severe and rapid desaturation. Recent guidelines recommend avoiding the suppression of spontaneous breathing in cases of predicted anatomically or physiologically difficult airway. Many different devices, such as video stylets and video laryngoscopes, have been proposed as alternatives to traditional gold standard flexible bronchoscope use for awake intubation. AimOur study reports the use of a new flexible ProVu™ Video Stylet (Flexicare Medical Ltd., Mountain Ash, UK) for awake intubations in 11 patients with severe obesity, who presented with at least one criterion for potentially difficult oxygenation (during ventilation and/or intubation attempts) after suppression of spontaneous breathing. MethodsIn total 11 consecutive patients with severe obesity and clinical indication for an awake tracheal intubation were enrolled over a 10-months period and intubated with the ProVu™ Video Stylet. ResultsAll 11 tracheal intubations were successfully performed. The procedures also highlighted potential limitations to consider while using the device in an awake intubation setting. ConclusionDespite the limitations of this small observational pilot study, our study showed that the ProVu™ Video Stylet may be a promising tool and a valid alternative for performing awake tracheal intubation in patients with severe obesity and predictors of difficult oxygenation. Future studies are needed to compare the performance of the ProVu™ Video Stylet with video laryngoscopy and flexible bronchoscopy, and to provide stronger evidence in favor or against the use of this new device. The possible availability of an alternative device, combined with the skill and confidence to use it, may provide the anesthesiologist an additional tool for managing awake intubation of at-risk airways, in accordance with recommendations from the most recent guidelines.

Can chin-nape circumference and the ratio of neck circumference to chin-nape circumference predict difficult mask ventilation or difficult intubation in obese patients?

We aimed to evaluate the success of the ratio of chin-nape circumference (CNC) and neck circumference (NC) to CNC in predicting difficult mask ventilation (DMV) or difficult intubation (DI). Eighty-seven obese patients (body mass index ≥ 30) were evaluated between September 15, 2019 and September 15, 2020. Mallampati score, mouth opening, upper lip bite test, distance between incisors, thyromental distance (TMD), sternomental distance (SMD), and thyromental height were recorded. NC and CNC were measured in a neutral position. The ratio of NC to TMD and the ratio of NC to CNC were calculated. Mask ventilation was graded according to the method described by Han et al (Grade 3 or 4 equals DMV). DI assessment was performed using the intubation difficulty scale (IDS, IDS < 5 equals easy intubation, IDS ≥ 5 equals DI). Logistic regression analysis was performed to identify the variables thought to be effective in DMV and DI. Receiver operating characteristic curves were generated for each parameter considered effective. DMV was found in 17.2% (n = 15) of the patients included in the study, and DI was found in 16.1% (n = 14). The relationship between DMV and age, male gender, obstructive sleep apnea syndrome, NC, ratio of NC to TMD, ratio of NC to SMD, ratio of NC to CNC, and CNC was significant. Male gender and NC >45.5 cm were independent risk factors for DMV. The relationship between DI and distance between incisors, NC, ratio of NC to TMD, ratio of NC to SMD, and CNC was significant. A distance between the incisors < 4.85 cm and a NC > 41.5 cm were found to be independent risk factors for DI. CNC may predict DMV and DI in obese patients. The ratio of NC to CNC may predict DMV in obese patients.

Comparison of Efficacy of Pressure Controlled vs. Traditional Manual Mask Ventilation for Newborn Resuscitation - A Simulation-Based Pilot Randomized Control Trial.

To determine efficacy of non-invasive positive pressure face mask ventilation using a ventilator device (NIPPmV) for achieving early effective ventilation compared to that by self-inflating bag (SIB) or T- piece resuscitator (TPR). The authors video recorded 33 trained resuscitators using NIPPmV (provided using ventilator device), SIB [a 500ml silicone SIB without a positive end expiratory pressure (PEEP) valve] and a TPR. Using a continuous pressure recording system and a neonatal manikin, the authors evaluated the efficacy of the ventilation to achieve early effective ventilation during 30s of ventilation. The primary outcome was time to achieve effective chest rise. Secondary outcomes were peak inspiratory pressure (PIP), ventilation rate and the need to perform ventilation corrective steps during positive pressure ventilation (PPV) among the devices. Total 99 videos were recorded. The time(s) taken to achieve the first chest rise was significantly lesser in NIPPmV group compared to SIB and TPR (3.0 ± 1.7 vs. 3.7 ± 1.9 vs. 7.5 ± 5.4, respectively, p <0.001). The mean PIPdelivered by NIPPmV compared to SIB & TPR(19.8 ± 1.6 vs. 35.6 ± 7.4 vs. 17.8 ± 2.0cm H20 respectively; p <0.001) was more accurate with preset PIP. Ventilation, in terms of breath rate, was observed to be controlled more accurately with NIPPmV compared to SIB & TPR(50 vs. 42 vs. 33 per min respectively;p <0.001). The non-invasive positive pressure face mask ventilation using a ventilator (NIPPmV) resulted in achieving early, effective and consistent ventilation.

Comparison of Facemask Ventilation Quality Between the Three-Finger Grip and the Three-Finger Grip Plus the Newly-Devised Submental Maneuver in Infants: A Double-Blind, Randomized Controlled Trial

Background: Mask ventilation is one of the most important aspects of managing and maintaining a patient's airway. Performing good mask ventilation can avoid the need for intubation. Objectives: This study aimed to compare the ventilation quality of two different mask-holding techniques in infants: The three-finger grip and the three-finger grip plus the newly-devised submental maneuver. Methods: This double-blind, randomized controlled trial included 90 infants under 1 year of age undergoing elective surgery under general inhalation anesthesia in Tehran Children's Medical Center. Each patient was randomly allocated to one of the interventional groups, and general anesthesia was induced using one of the mask-holding techniques before intubation. Demographic data for each patient was collected. Expired tidal volume (VTE) was assessed quantitatively by the Drager machine and then classified into three groups of quality of breath flow as either good (5 - 7 mL/kg), fair (3 - 5 mL/kg), or bad (&lt; 3 mL/kg). Results: In this study, VTE was shown to be statistically significantly better in the submental maneuver compared with the three-finger grip. Good, fair, and bad qualities were recorded for 30, 15, and 0 patients in the three-finger grip group and 39, 6, and 0 patients in the submental maneuver group, respectively (P = 0.025). Classifying patients into four groups of body mass index (BMI), 10 - 14, 15 - 19, 20 - 24, and 25 - 29, we compared VTE between the two techniques within each group. The results showed that in the BMI group of 20 - 24, the quality of breath flow was statistically significantly better in the submental maneuver (P = 0.047). Conclusions: Adding the submental maneuver to the three-finger grip seems to provide better expired tidal volume in infants. Also, it seems that in children with higher BMI and larger submental soft tissue, the submental maneuver provides better ventilation quality than the three-finger grip.

Significance of Neonatal Heart Rate in the Delivery Room-A Review.

Heart rate (HR) is considered the main vital sign in newborns during perinatal transition, with a threshold of 100 beats per minute (bpm), below which, intervention is recommended. However, recent changes in delivery room management, including delayed cord clamping, are likely to have influenced normal HR transition. To summarize the updated knowledge about the factors, including measurement methods, that influence HR in newborn infants immediately after birth. Additionally, this paper provides an overview of delivery room HR as a prognostic indicator in different subgroups of newborns. We searched PubMed, EMBASE, and Google Scholar with the terms infant, heart rate, delivery room, resuscitation, pulse oximetry, and electrocardiogram. Seven studies that described HR values in newborn infants immediately after birth were included. Pulse oximetry-derived HR percentiles after immediate cord clamping may not be applicable to the current practice of delayed cord clamping and the increasing use of delivery room electrocardiograms. Mask ventilation may adversely affect HR, particularly in premature and non-asphyxiated infants. Prolonged bradycardia is a negative prognostic factor, especially if combined with hypoxemia in infants <32 weeks of gestation. HR assessment in the delivery room remains important. However, the cardiopulmonary transition is affected by delayed cord clamping, gestational age, and underlying conditions.

To Evaluate Usefulness of Stop-Bang Questionnaire in Predicting Difficult Bag Mask Ventilation and Difficult Intubation in Adult Patients for Elective Surgery: Important Guide for Obstructive Sleep Apnea Patients

Introduction: Obstructive sleep apnea (OSA) is a condition with repetitive interruptions to breathing due to obstruction of the airway in sleep. We evaluated STOP-BANG score outcome. Aim and Objective: To evaluate the usefulness of stop-bang questionnaire in predicting difficult bag mask ventilation and difficult intubation (DIT) with comparison. Materials and Methods: A prospective, simple randomized, comparative study was on 100 patients. Results: O group had male preponderance, higher American Society of Anesthesiologists grades along with comorbidities, higher mallampati grades, lower sternomental distance and thyromental distance, and higher neck circumference. Mean time in study group was 31.7 s and in control group was 18.68 s. Conclusion: We conclude that patients with STOP-BANG score ≥3 are at higher risk of unanticipated difficult mask ventilation and DIT in undiagnosed cases of OSA.

Use of Transparent Film Dressing to Facilitate Mask Ventilation in Bearded Patients

BackgroundMask ventilation is a critical airway procedure made more difficult in the bearded patient. ObjectiveWe sought to objectively investigate whether application of transparent cling film (TegadermTM; 3M Healthcare, Maplewood, MN) over a beard in the operating room improves the quality of mask ventilation. MethodsThis was a randomized crossover trial of bearded adult patients undergoing surgery. Exclusions included emergency procedures, American Society of Anesthesiologists physical status classification > 3, a documented history of difficult mask ventilation, and body mass index (BMI) > 50. Transparent cling film was applied snuggly over the lower face with a 2- to 3-cm slit cut over the mouth after anesthesia induction. Mask ventilation performed by an anesthesiology resident, anesthesiology assistant, or anesthesiology assistant student and standardized to a thenar-eminence grip without use of airway adjuncts in a sniffing position. Standardized pressure-controlled ventilations were delivered via an anesthesia machine. A calibrated external pneumotachograph was used to measure delivered and returned tidal volumes from which raw and percent air leak were calculated. A clinically significant difference was determined a priori to be 15%, necessitating the enrollment of 25 patients. ResultsOf 25 subjects, 96% were men with a mean ± SD BMI of 29.3 ± 6. Seventeen (68%) had a full beard and 8 (32%) had a partial beard. The mean ± SD leakage was 48% ± 26% for transparent cling film vs. 46% ± 20% without its application, which was not significantly different (p = 0.67). ConclusionsThe use of transparent cling film to cover the lower half of the bearded face did not have an impact on the ability or efficacy to perform mask ventilation in the operating room setting. ClinicalTrials.gov, Number NCT04274686.

Prevalence and risk factors of difficult mask ventilation: A systematic review and meta-analysis

Study objectiveThis meta-analysis aimed at identifying the risk factors for and their strengths in predicting difficult mask ventilation (MV) through a systematic approach. DesignMeta-analysis of observational studies. SettingOperating room. InterventionAirway- or patient-related risk factors for difficult MV reported in over 20% of eligible studies identified through literature review. PatientsAdults receiving anesthetic induction with requirement of MV. MeasurementsDatabases including EMBASE, MEDLINE, Google Scholar, and Cochrane Library were searched from inception to July 2022. The primary outcomes were the identification of commonly reported risk factors for MV and a comparison of their strengths in difficult MV prediction, while the secondary outcomes were the prevalence of difficult MV in the general population and those with obesity. Main resultsMeta-analysis of 20 observational studies involving 335,846 patients identified 13 risk factors with predictive strengths (all p < 0.05): neck radiation (OR = 5.0, five studies, n = 277,843), increased neck circumference (OR = 4.04, 11 studies, n = 247,871), obstructive sleep apnea (OSA) (OR = 3.61, 12 studies, n = 331,255), presence of beard (OR = 3.35, 12 studies, n = 295,443), snoring (OR = 3.06, 14 studies, n = 296,105), obesity (OR = 2.99, 11 studies, n = 278,297), male gender (OR = 2.76, 16 studies, n = 320,512), Mallampati score III-IV (OR = 2.36, 17 studies, n = 335,016), limited mouth opening (OR = 2.18, six studies, n = 291,795), edentulous (OR = 2.12, 11 studies, n = 249,821), short thyroid-mental distance (OR = 2.12, six studies, n = 328,311), old age (OR = 2, 11 studies, n = 278,750), and limited neck movement (OR = 1.98, nine studies, n = 155,101). The prevalence of difficult MV was 6.1% (16 studies, n = 334,694) and 14.4% (four studies, n = 1152) in the general population and those with obesity, respectively. ConclusionsOur results demonstrated the strengths of 13 most common risk factors for predicting difficult MV, which may serve as an evidence-based reference for clinicians to incorporate into their daily practice.

PREOPERATIVE SINGLE ANTHROPOMETRIC SCREENING TESTS OF DIFFICULT FACE MASK VENTILATION AND DIFFICULT DIRECT LARYNGOSCOPY INTUBATION IN PATIENTS UNDERGOING OTORHINOLARYNGOLOGICAL SURGERY: A PROSPECTIVE, OBSERVATIONAL, SINGLE CENTER STUDY.

The aim of this study was to assess preoperative airway history data and single anthropometric screening tests of difficult face mask ventilation (FMV) and difficult direct laryngoscopy intubation (DLI) in otorhinolaryngological surgery. Final analysis included 62 patients aged ≥14 years undergoing elective surgery with endotracheal intubation at a single center during a one-month period. Data on difficult intubation history, airway symptoms and pathology related to difficult airway were prospectively collected. Han scoring classification of FMV and Intubation Difficulty Score (IDS) were used. There were 14 (22.6%) patients with a history of current airway tumors or abscesses. Only two (3.2%) patients were preoperatively evaluated as anticipated difficult airway. Both were slightly difficult to ventilate and scored IDS 5 and IDS 8. FMV was graded as easy in 50 (80.5%), slightly difficult in 10 (16.1%) and difficult in 2 (3.2%) cases. There were 29 (46.78%) slightly difficult DLIs and one (1.6%) case of difficult DLI. The study confirmed clinically relevant incidence of difficulties with FMV and DLI in otorhinolaryngologic surgery patients. However, there should be stronger evidence to identify a single preoperative variable predicting difficult airway.

A prospective randomized study of different height of operation table for tracheal intubation with videolaryngoscopy in ramped position

BackgroundPrevious studies have reported that the ramped position provides a better laryngoscopic view, reduces tracheal intubation time, and increases the success rate of endotracheal intubation. However, the patient’s head height changes while in the ramped position, which in turn changes the relative positions of the patient and intubator. Thus, making these changes may affect the efficiency of tracheal intubation; however, few studies have addressed this problem. This study analyzed intubation time and conditions during tracheal intubation using videolaryngoscope in the ramped position.MethodsThis prospective study included 144 patients who were scheduled to receive general anesthesia for surgeries involving orotracheal intubation. The participants were randomly allocated to either the nipple or umbilical group according to the table height. Mask ventilation was assessed using the Warters grading scale. Tracheal intubation was performed using a McGrath MAC laryngoscope. The total intubation time, laryngoscopy time, tube insertion time, and difficulty of intubation (IDS score) were measured.ResultsThe umbilical group had a significantly shorter laryngoscopy time (10 ± 3 vs. 16 ± 4 s), tube insertion time (18 ± 4 vs. 24 ± 6 s), and total intubation time (28 ± 5 vs. 40 ± 7 s) compared to the nipple group. No significant difference in the difficulty of mask ventilation was observed between the two groups. The IDS score was higher in the nipple than umbilical group.ConclusionThe lower (umbilical) table level reduced the intubation time and difficulty of videolaryngoscopy compared to the higher (nipple) table level.Trial registrationThis study was registered at KCT0005987, 11/03/2021, Retrospectively registered.

COMPARISON OF PREOPERATIVE AIRWAY INDICES, BODY MASS INDEX (BMI), WITH INTRA-OPERATIVE VISUALISATION OF VOCAL CORDS AND DIFFICULTY WITH MASK VENTILATION AND INTUBATION IN SNORERS AND NON SNORERS

Introduction : Prediction of difcult intubation before induction of anaesthesia is not easy but very important. 'Difcult airway' is a clinical situation where there is difculty in establishing or maintaining gas exchange via a mask, an articial airway or both by a conventionally trained anaesthesiologist.Here we focussed on the utility of individual upper airway evaluation by physical examination and its usefulness in predicting a difcult airway among people who snore. Aim: Ÿ To Compare Airway Indices, Body Mass Index (BMI), Cormack - Lehane Grading and Difculty with Mask Ventilation and Intubation Ÿ To determine the most reliable single parameter in identifying difcult airway. Methods: After obtaining approval from institutional ethics committee and written informed consent from the patients between 18 and 60yrs of age, of either sex, requiring general anaesthesia with endotracheal intubation for elective procedures the following anatomical markers are measured -Mouth opening (inter incisor distance), Modied MallampatiScore (MMPT), Thyromental distance (TMD), Neck circumference, Neck extension, Thyomental height, Cormack lehane's grading. Cormack lehane grades I, II were dened as easy visualization of larynx (EVL) and predict easy intubation.Grades III and IV were dened as difculty in visualization of larynx (DVL) and predict difcult intubation. Data Entry was done using Microsoft excel 2013 and analysis done using SPSS V 16. Qualitative data was expressed in frequencies and percentages and Quantitative data in mean and standard deviation .p value of &lt;0.05 was considered statistically signicant.

Comparison of methylprednisolone pulse vs conventional dexamethasone for adult cases of COVID-19 requiring oxygen; a Japanese retrospective cohort study

BackgroundAlthough dexamethasone is an effective treatment in cases of coronavirus disease 2019 (COVID-19) requiring oxygen, the efficacy of methylprednisolone pulse is unclear. We compared the characteristics and outcomes of methylprednisolone pulse to those of dexamethasone. MethodsWe conducted a retrospective cohort study on adult COVID-19 cases requiring oxygen and no invasive mechanical ventilation treated with methylprednisolone pulse (1 g/day for 3 days) or dexamethasone (6 mg/day orally or 6.6 mg/day intravenously for ≥5 days). The primary outcome was intensive care unit (ICU) admission. The secondary outcomes were hospital mortality, length of hospital stay (LoS), duration of oxygen requirement, and requirement for hospital transfer, vasopressor(s), intubation, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). ResultsTwenty two cases of methylprednisolone pulse and 77 cases of dexamethasone were included. Mask ventilation was more common in the methylprednisolone pulse group (P < 0.001). The proportion of ICU admissions was similar between both groups (P = 0.635). The secondary outcomes of hospital mortality and the requirement for hospital transfer, vasopressor(s), intubation, and CRRT were similar between groups. No cases received ECMO. Median LoS (P = 0.006) and duration of oxygen requirement (P = 0.004) were longer in the methylprednisolone pulse group. ConclusionsThe proportion of ICU admissions was similar between the methylprednisolone pulse and the dexamethasone group. However, more cases in the methylprednisolone pulse group required mask ventilation than in the dexamethasone group, suggesting that some cases benefited from methylprednisolone pulse.