Mask Ventilation during Induction of General Anesthesia

Shin Sato, Makoto Hasegawa, Megumi Okuyama, Junko Okazaki, Yuji Kitamura, Yumi Sato, Teruhiko Ishikawa, Yasunori Sato, Shiroh Isono

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Depending on upper airway patency during anesthesia induction, tidal volume achieved by mask ventilation may vary. In 80 adult patients undergoing general anesthesia, the authors tested a hypothesis that tidal volume during mask ventilation is smaller in patients with sleep-disordered breathing priorly defined as apnea hypopnea index greater than 5 per hour. Methods: One-hand mask ventilation with a constant ventilator setting (pressure-controlled ventilation) was started 20 s after injection of rocuronium and maintained for 1 min during anesthesia induction. Mask ventilation efficiency was assessed by the breath number needed to initially exceed 5 ml/kg ideal body weight of expiratory tidal volume (primary outcome) and tidal volumes (secondary outcomes) during initial 15 breaths (UMIN000012494). Results: Tidal volume progressively increased by more than 70% in 1 min and did not differ between sleep-disordered breathing (n = 42) and non-sleep-disordered breathing (n = 38) patients. In post hoc subgroup analyses, the primary outcome breath number (mean [95% CI], 5.7 [4.1 to 7.3] vs. 1.7 [0.2 to 3.2] breath; P = 0.001) and mean tidal volume (6.5 [4.6 to 8.3] vs. 9.6 [7.7 to 11.4] ml/kg ideal body weight; P = 0.032) were significantly smaller in 20 sleep-disordered breathing patients with higher apnea hypopnea index (median [25th to 75th percentile]: 21.7 [17.6 to 31] per hour) than in 20 non-sleep disordered breathing subjects with lower apnea hypopnea index (1.0 [0.3 to 1.5] per hour). Obesity and occurrence of expiratory flow limitation during one-hand mask ventilation independently explained the reduction of efficiency of mask ventilation, while the use of two hands effectively normalized inefficient mask ventilation during one-hand mask ventilation. Conclusions: One-hand mask ventilation is difficult in patients with obesity and severe sleep-disordered breathing particularly when expiratory flow limitation occurs during mask ventilation.

Original languageEnglish
Pages (from-to)28-38
Number of pages11
JournalAnesthesiology
Volume126
Issue number1
DOIs
Publication statusPublished - 2017 Jan 1
Externally publishedYes

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Masks
General Anesthesia
Tidal Volume
Sleep Apnea Syndromes
Hand
Apnea
Ideal Body Weight
Respiration
Anesthesia
Morbid Obesity
Mechanical Ventilators
Ventilation
Obesity
Pressure
Injections

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Sato, S., Hasegawa, M., Okuyama, M., Okazaki, J., Kitamura, Y., Sato, Y., ... Isono, S. (2017). Mask Ventilation during Induction of General Anesthesia. Anesthesiology, 126(1), 28-38. https://doi.org/10.1097/ALN.0000000000001407

Mask Ventilation during Induction of General Anesthesia. / Sato, Shin; Hasegawa, Makoto; Okuyama, Megumi; Okazaki, Junko; Kitamura, Yuji; Sato, Yumi; Ishikawa, Teruhiko; Sato, Yasunori; Isono, Shiroh.

In: Anesthesiology, Vol. 126, No. 1, 01.01.2017, p. 28-38.

Research output: Contribution to journalArticle

Sato, S, Hasegawa, M, Okuyama, M, Okazaki, J, Kitamura, Y, Sato, Y, Ishikawa, T, Sato, Y & Isono, S 2017, 'Mask Ventilation during Induction of General Anesthesia', Anesthesiology, vol. 126, no. 1, pp. 28-38. https://doi.org/10.1097/ALN.0000000000001407
Sato S, Hasegawa M, Okuyama M, Okazaki J, Kitamura Y, Sato Y et al. Mask Ventilation during Induction of General Anesthesia. Anesthesiology. 2017 Jan 1;126(1):28-38. https://doi.org/10.1097/ALN.0000000000001407
Sato, Shin ; Hasegawa, Makoto ; Okuyama, Megumi ; Okazaki, Junko ; Kitamura, Yuji ; Sato, Yumi ; Ishikawa, Teruhiko ; Sato, Yasunori ; Isono, Shiroh. / Mask Ventilation during Induction of General Anesthesia. In: Anesthesiology. 2017 ; Vol. 126, No. 1. pp. 28-38.
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