Evaluation of changes in tidal volume during mask ventilation following administration of neuromuscular blocking drugs

Abstract

SummaryThe practice of checking the ability to mask ventilate before administering neuromuscular blocking drugs remains controversial. We prospectively evaluated the changes in the expired tidal volume during pressure-controlled ventilation (two-handed mask ventilation technique) as a surrogate marker to assess the ease of mask ventilation following administration of rocuronium. After informed consent, 125 patients were anaesthetised using a standard induction technique consisting of fentanyl, propofol and rocuronium, with anaesthesia then maintained with isoflurane in oxygen. The mean (SD) expired tidal volume before administration of rocuronium increased by 61 (13) ml at 2 min following onset of neuromuscular block (p < 0.001). This supports the concept that neuromuscular blockade induced by rocuronium facilitates mask ventilation.

All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults

“…Neuromuscular block results in apnoea, abolishes the laryngeal reflexes, improves chest wall compliance[2122] and thus can improve the chances of successful airway management when face mask ventilation is difficult. [23] During rapid sequence induction, either rocuronium or succinylcholine may be used unless contraindicated.…”

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

“…Rapid sequence induction accounted for most occasions when thiopental was administered, and this combination appeared to be an important risk factor for AAGA. Relevant questions include: whether co-administration of opioids or other adjuncts lowers the risk of AAGA while still achieving the goals of rapid sequence induction; whether there is time to assess the effect of the induction agent and provide more if needed; whether the administration of the rapidly acting neuromuscular blocking drug can be delayed slightly to check the conscious level, and/or even check the ease of bag-mask ventilation [35][36][37][38], itself a test of depth of anaesthesia; and whether thiopental should continue to have a place. The high proportion of AAGA cases associated with failed, prolonged or difficult airway management indicates an overlap between the findings of NAP4 [39] and NAP5.…”

Face‐mask ventilation: the neglected essentials?

“…However, recent evidence is increasingly challenging these theoretical arguments. Several studies have now demonstrated that neuromuscular blockade can, in fact, facilitate FMV, rather than hamper it . Secondly, the concept of waking up or return of spontaneous ventilation after administration of either short‐acting NMBDs or anaesthetic agents alone has not been shown to be reliable.…”

“…It was thought that neuromuscular blockade, although it might assist FMV, could also hamper it by collapsing the airway and lead to airway obstruction [15]. [16][17][18][19].…”