A Two-handed Jaw-thrust Technique Is Superior to the One-handed “EC-clamp” Technique for Mask Ventilation in the Apneic Unconscious Person
- 1 October 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesiology
- Vol. 113 (4), 873-879
- https://doi.org/10.1097/aln.0b013e3181ec6414
Abstract
Background Mask ventilation is considered a "basic" skill for airway management. A one-handed "EC-clamp" technique is most often used after induction of anesthesia with a two-handed jaw-thrust technique reserved for difficult cases. Our aim was to directly compare both techniques with the primary outcome of air exchange in the lungs. Methods Forty-two elective surgical patients were mask-ventilated after induction of anesthesia by using a one-handed "EC-clamp" technique and a two-handed jaw-thrust technique during pressure-control ventilation in randomized, crossover fashion. When unresponsive to a jaw thrust, expired tidal volumes were recorded from the expiratory limb of the anesthesia machine each for five consecutive breaths. Inadequate mask ventilation and dead-space ventilation were defined as an average tidal volume less than 4 ml/kg predicted body weight or less than 150 ml/breath, respectively. Differences in minute ventilation and tidal volume between techniques were assessed with the use of a mixed-effects model. Results Patients were (mean ± SD) 56 ± 18 yr old with a body mass index of 30 ± 7.1 kg/m. Minute ventilation was 6.32 ± 3.24 l/min with one hand and 7.95 ± 2.70 l/min with two hands. The tidal volume was 6.80 ± 3.10 ml/kg predicted body weight with one hand and 8.60 ± 2.31 ml/kg predicted body weight with two hands. Improvement with two hands was independent of the order used. Inadequate or dead-space ventilation occurred more frequently during use of the one-handed compared with the two-handed technique (14 vs. 5%; P = 0.013). Conclusion A two-handed jaw-thrust mask technique improves upper airway patency as measured by greater tidal volumes during pressure-controlled ventilation than a one-handed "EC-clamp" technique in the unconscious apneic person.Keywords
This publication has 22 references indexed in Scilit:
- Comparison of three modes of positive pressure mask ventilation during induction of anaesthesia: a prospective, randomized, crossover studyEuropean Journal of Anaesthesiology, 2009
- The adult ergonomic face mask concept: historical and theoretical perspectivesJournal of Clinical Anesthesia, 2009
- Incidence and Predictors of Difficult and Impossible Mask VentilationAnesthesiology, 2006
- The incidence and risk factors of difficult mask ventilationJournal of Anesthesia, 2005
- Mechanical Versus Manual Ventilation via a Face Mask During the Induction of Anesthesia: A Prospective, Randomized, Crossover StudyAnesthesia & Analgesia, 2004
- Prediction of Difficult Mask VentilationAnesthesiology, 2000
- The “Educated Hand” Can Anesthesiologists Assess Changes in Neonatal Pulmonary Compliance ManuallyAnesthesiology, 1991
- Accuracy of Manual VentilationAnesthesiology, 1964
- Upper airway obstruction in the unconscious patientJournal of Applied Physiology, 1959
- A Comparison of the Mouth-to-Mouth and Mouth-to-Airway Methods of Artificial Respiration with the Chest-Pressure Arm-Lift MethodsNew England Journal of Medicine, 1958