Comparison of Effectiveness of CE Technique and Jaw Thrust Technique for Mask Ventilation on Apneic Anesthetized Adults

Abstract

Background: The two most common techniques for mask ventilation are CE and jaw thrust (JT) technique. However, few studies have validated their efficiency in terms of tidal volume (TV). Aims: This study aimed to compare the effectiveness of the CE technique and JT technique during pressure-controlled ventilation (PCV) by the mean of returned TV on apneic anesthetized adults. Design: This was a prospective, randomized cross over study. Settings: This study was conducted in a tertiary care hospital. Methods: Ethical Committee approval from our institution was taken (ss-1/EC 049/2017) and was registered in Clinical Trials Registry of India (CTRI/2018/04/012958). Sixty-five American Society of Anesthesiologists Physical Status classes I and II adult patients were enrolled in the study. After induction and muscle relaxation, mask ventilation was performed with CE and JT technique on PCV mode (Pinsp 15 cm H 2 O, respiratory rate 15) for 1 min each. The mean of returned TV of last 12 breaths, gastric insufflation, audible mask leak, and operator comfort in each technique were compared. Statistical Analysis: Statistical software namely IBM SPSS 22.0 and R environment version 3.2.2 (IBM Corp. SPSS Statistics for Windows, Version 22.0. Armonk, NY, USA) were used for data analysis. Microsoft Excel was used to generate graphs and tables. Data were expressed as mean ± standard deviation for continuous variables and number (%) for categorical variables. Student's t -test (two tailed, independent) was used to find the significance of the study parameters on a continuous scale. Chi-square/Fisher's exact test was used to find the significance of the study parameters on a categorical scale between two or more groups. Results: There was a significant increase in mean TV generated by JT technique over CE technique (591.46 ± 140.27 mL vs. 544.59 ± 159.08 mL; P < 0.001). Gastric insufflation (12.9% vs. 14.5%) and mask leak (11.3% vs. 38.7%) were more in CE technique. Operator comfort (79% vs. 19.4%) was more in JT technique. Conclusion: A two-handed JT technique is more effective than a one-handed CE technique for mask ventilation in apneic anesthetized adults.

A special face mask with integrated angle meter to optimize the head position for bag-valve-mask ventilation—a prospective simulated proof-of-concept study

“…However, the most experienced anesthesiologists did not know the difficulties and the trainings required for simultaneously tilting the head into correct position, sealing the facemask and providing tidal volumes with a bag valve device [5][6][7]. The proper BVM ventilation could improve its performance particularly for the less experienced rescuers [6,8,9]. A tilted head position to 43 degrees compared to the horizontal plane had been effective in opening the upper airway, as observed in magnetic resonance tomography based studies [10,11].…”