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Excerpt
Background and goals of study: Nasal mask ventilation has been used as a form of respiratory support in the intensive care unit [1]. Previously, this form of ventilation has had no recognized role in the anaesthetic setting, although in our experience it is sometimes more effective than facemask ventilation in the edentulous or obese patient. Our goal was to determine if ventilation solely through the nose is an effective alternative to conventional facemask ventilation during induction of anaesthesia.
Materials and methods: After ethics committee approval, informed consent was obtained in 30 patients aged 14 and above, ASA I-III, undergoing general anaesthesia for elective surgery. Patients were randomized to receive either conventional facemask ventilation or nasal mask ventilation, after induction of anaesthesia with propofol (2-3 mg kg−1) and fentanyl (1 μg kg−1). Muscle relaxants, if used, were not given until after the period of assessment. The masks used were clear and padded. Infant and toddler sizes acted as nasal masks. For facemask ventilation, an oral airway was inserted. In the nasal mask group no airway was used, the mouth was kept firmly closed, and ventilation attempted solely through the nose. Success was defined as visible rising of the chest wall on inspiration and the presence of an end-tidal carbon dioxide trace for five successive breaths. We looked at the success rates at first and second attempts and ease of use of the two techniques. Statistical analysis was done using the χ2 test.
Results and discussion: The overall success rate in the two groups (n= 15 in each group) was identical (93% or 14 out of 15). Success at the first attempt in the nasal mask group occurred in 12 out of 15 patients, as opposed to nine out of 15 patients in the conventional mask group. The nasal mask technique was stated to be easy to use in 13 out of 15 attempts, versus 10 out of 15 attempts in the conventional mask group. The differences were not statistically significant.
Conclusion: Nasal mask ventilation is an effective alternative to conventional facemask ventilation at induction of anaesthesia.
