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GENERAL ARTICLES

Mechanical Versus Manual Ventilation via a Face Mask During the Induction of Anesthesia: A Prospective, Randomized, Crossover Study

Achim von Goedecke, MD^*, Wolfgang G. Voelckel, MD^*, Volker Wenzel, MD^*, Christoph Hörmann, MD^*, Horst G. Wagner-Berger, MD^*, Volker Dörges, MD, Karl H. Lindner, MD^*, and Christian Keller, MD^*

*Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria; and Department of Anesthesiology and Intensive Care Medicine, University Hospital of Kiel, Kiel, Germany

Address correspondence and reprint requests to Achim von Goedecke, MD, Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Anichstrasse 35, 6020 Innsbruck, Austria. Address e-mail to achim.von-goedecke{at}uibk.ac.at

One approach to make ventilation safer in an unprotected airway has been to limit tidal volumes; another one might be to limit peak airway pressure, although it is unknown whether adequate tidal volumes can be delivered. Accordingly, the purpose of this study was to evaluate the quality of automatic pressure-controlled ventilation versus manual circle system face-mask ventilation regarding ventilatory variables in an unprotected airway. We studied 41 adults (ASA status I–II) in a prospective, randomized, crossover design with both devices during the induction of anesthesia. Respiratory variables were measured with a pulmonary monitor (CP-100). Pressure-controlled mask ventilation versus circle system ventilation resulted in lower (mean ± SD) peak airway pressures (10.6 ± 1.5 cm H₂O versus 14.4 ± 2.4 cm H₂O; P < 0.001), airway pressures (8.5 ± 1.5 cm H₂O versus 11.9 ± 2.3 cm H₂O; P < 0.001), expiratory tidal volume (650 ± 100 mL versus 680 ± 100 mL; P = 0.001), minute ventilation (10.4 ± 1.8 L/min versus 11.6 ± 1.8 L/min; P < 0.001), and peak inspiratory flow rates (0.81 ± 0.06 L/s versus 1.06 ± 0.26 L/s; P < 0.001) but higher inspiratory time fraction (48% ± 0.8% versus 33% ± 7.7%; P < 0.001) and end-tidal carbon dioxide (34 ± 3 mm Hg versus 33 ± 4 mm Hg; not significant). We conclude that in this model of apneic patients with an unprotected airway, pressure-controlled ventilation resulted in reduced inspiratory peak flow rates and peak airway pressures when compared with circle system ventilation, thus providing an additional patient safety effect during mask ventilation.

IMPLICATIONS: In this model of apneic patients with an unprotected airway, pressure-controlled ventilation resulted in reduced inspiratory peak flow rates and lower peak airway pressures when compared with circle system ventilation, thus providing an additional patient safety effect during face-mask ventilation.

This article has been cited by other articles:

				J. Garcia-Fernandez, G. Tusman, F. Suarez-Sipmann, J. Llorens, M. Soro, and J. F. Belda Programming Pressure Support Ventilation in Pediatric Patients in Ambulatory Surgery with a Laryngeal Mask Airway Anesth. Analg., December 1, 2007; 105(6): 1585 - 1591. [Abstract] [Full Text] [PDF]

				A. von Goedecke, C. Keller, H. G. Wagner-Berger, W. G. Voelckel, C. Hormann, A. Zecha-Stallinger, and V. Wenzel Developing a Strategy to Improve Ventilation in an Unprotected Airway with a Modified Mouth-to-Bag Resuscitator in Apneic Patients Anesth. Analg., November 1, 2004; 99(5): 1516 - 1520. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999