Traditionally, there are two main methods of mask placement during face mask ventilation: one handed (CE) grip and two handed grip (THT). One handed grip is limited by air leaks between mask and patients face on the s...Traditionally, there are two main methods of mask placement during face mask ventilation: one handed (CE) grip and two handed grip (THT). One handed grip is limited by air leaks between mask and patients face on the side opposite to stabilizing hand. Two handed grips provide protection against air leak but require second provider to deliver tidal volumes when using a self inflating bag or anesthesia circuit on manual ventilation. This study introduces modified CE grip which creates a firm seal at patient’s face on both sides of mask, enabling adequate tidal volume delivery with provider’s second hand. Using left hand, provider places the fifth digit along inferior border of body of left mandible. The fourth digit is placed along inferior border of body right mandible. Standing 6 inches to the left and immediately behind a supine patient on an OR table, provider rotates clockwise 45 degrees at hip, keeping elbow against their body, and lifts patient’s chin to 45 degrees. Rotational force at hip augments hand strength while tilting chin. The thumb applies pressure along left border of facemask, and the second and third digits apply pressure to right border of facemask. Methods: Patients with known predictors of difficult mask ventilation (Edentulous, bearded, Obstructive sleep apnea (OSA), mallampati 3 or 4) were in experimental group. Normal patients assigned as Controls. After induction of general anesthesia, provider ventilated patient using adult sized facemask. The anesthesia ventilator delivered standardized tidal volumes. TV, airway pressures, HR and O2 saturation were recorded after each breath. Results: All groups, except OSA, showed improvement, in tidal volumes with the novel technique compared to the traditional CE grip. Conclusion: The novel submandibular technique, an important skill, increases tidal volumes during mask ventilation for certain high risk patients.展开更多
Airway ultrasound allows for precise airway evaluation,particularly for assessing the difficult airway and the potential for front of neck access.Many studies have shown that identification of the cricothyroid membran...Airway ultrasound allows for precise airway evaluation,particularly for assessing the difficult airway and the potential for front of neck access.Many studies have shown that identification of the cricothyroid membrane by airway ultrasound is more accurate than digital palpation.However,no reports to date have provided clinical evidence that ultrasound identification of the cricothyroid membrane increases the success rate of cricothyroidotomy.This is a narrative review which describes patients with difficult airways for whom airway ultrasound may have been useful for clinical decision making.The role of airway ultrasound for the evaluation of difficult airways is summarized and an approach to the use of ultrasound for airway management is proposed.The goal of this review is to present practical applications of airway ultrasound for patients predicted to have a difficult airway and who undergo cricothyroidotomy.展开更多
文摘Traditionally, there are two main methods of mask placement during face mask ventilation: one handed (CE) grip and two handed grip (THT). One handed grip is limited by air leaks between mask and patients face on the side opposite to stabilizing hand. Two handed grips provide protection against air leak but require second provider to deliver tidal volumes when using a self inflating bag or anesthesia circuit on manual ventilation. This study introduces modified CE grip which creates a firm seal at patient’s face on both sides of mask, enabling adequate tidal volume delivery with provider’s second hand. Using left hand, provider places the fifth digit along inferior border of body of left mandible. The fourth digit is placed along inferior border of body right mandible. Standing 6 inches to the left and immediately behind a supine patient on an OR table, provider rotates clockwise 45 degrees at hip, keeping elbow against their body, and lifts patient’s chin to 45 degrees. Rotational force at hip augments hand strength while tilting chin. The thumb applies pressure along left border of facemask, and the second and third digits apply pressure to right border of facemask. Methods: Patients with known predictors of difficult mask ventilation (Edentulous, bearded, Obstructive sleep apnea (OSA), mallampati 3 or 4) were in experimental group. Normal patients assigned as Controls. After induction of general anesthesia, provider ventilated patient using adult sized facemask. The anesthesia ventilator delivered standardized tidal volumes. TV, airway pressures, HR and O2 saturation were recorded after each breath. Results: All groups, except OSA, showed improvement, in tidal volumes with the novel technique compared to the traditional CE grip. Conclusion: The novel submandibular technique, an important skill, increases tidal volumes during mask ventilation for certain high risk patients.
文摘Airway ultrasound allows for precise airway evaluation,particularly for assessing the difficult airway and the potential for front of neck access.Many studies have shown that identification of the cricothyroid membrane by airway ultrasound is more accurate than digital palpation.However,no reports to date have provided clinical evidence that ultrasound identification of the cricothyroid membrane increases the success rate of cricothyroidotomy.This is a narrative review which describes patients with difficult airways for whom airway ultrasound may have been useful for clinical decision making.The role of airway ultrasound for the evaluation of difficult airways is summarized and an approach to the use of ultrasound for airway management is proposed.The goal of this review is to present practical applications of airway ultrasound for patients predicted to have a difficult airway and who undergo cricothyroidotomy.
