EdenteV2, Main, Exploration, bibRecord, 000B70

Ventilation by mask before and after the administration of neuromuscular blockade: a pragmatic non-inferiority trial

Identifieur interne : 000B70 ( Main/Exploration ); précédent : 000B69; suivant : 000B71

Ventilation by mask before and after the administration of neuromuscular blockade: a pragmatic non-inferiority trial

Auteurs : Aaron M. Joffe [États-Unis] ; Ramesh Ramaiah [États-Unis] ; Eric Donahue [États-Unis] ; Richard E. Galgon [États-Unis] ; Stephan R. Thilen [États-Unis] ; Charles F. Spiekerman [États-Unis] ; Sanjay M. Bhananker [États-Unis]

Source :

BMC Anesthesiology [ 1471-2253 ] ; 2015.

RBID : PMC:4596367

Abstract

Background

Test ventilating prior to administration of neuromuscular blockade (NMB) in order to avoid a cannot intubate-cannot ventilate situation is a classic anesthesia teaching. The primary aim of our study was to show that facemask ventilation (FMV) after NMB was not inferior to FMV prior to NMB with respect to exhaled gas volumes before and after their administration.

Methods

This study was approved by the University of Washington Human Subjects Division (Seattle, Washington, USA). Written informed consent was obtained from all patients. Measurements of tidal volume (Vte) as well as other respiratory parameters during FMV were made for 60 s after induction of anesthesia and again after NMB. Difficult, impossible, inadequate, and dead-space only mask ventilation was graded using published definitions. Difficult intubation was defined as >2 attempts at intubation. The primary outcome was non-inferiority in Vte during both study periods defined as a mean difference of <50 mL. Multivariate analysis was performed to assess for interaction between operator experience, patient risk factors for difficult mask ventilation, exhaled volumes, and use of airway adjuncts.

Results

Two-hundred and ten patients were studied. Overall, FMV improved after NMBD. The mean (SD) V_te in mL/breath increased from 399 (169) to 428 (166) (mean dif. 30 mL, p = 0.001) and the minute ventilation in L/min from 5.6 (2.5) to 6.3 (2.5) (mean dif. 0.6, p < 0.001). No patient who was difficult to ventilate after induction became impossible after NMB.

Discussion

In patients at risk for or judged to be a difficult FMV by clinical grading scales, tidal volumes improved after administration of NMBDs. None of these patients exhibited a decline in ventilation or became impossible to ventilate after NMBDs. Several limitations are noted, including the use of hand-delivered breaths and inability to account for time-related changes in ventilation conditions independent of NMBDs.

Conclusion

We conclude that FMV is no worse after NMB than before and is likely to improve airway conditions.

Trial Registration

ClinicalTrials.gov Identifier: NCT02237443. Registered August 28, 2014

Electronic supplementary material

The online version of this article (doi:10.1186/s12871-015-0111-z) contains supplementary material, which is available to authorized users.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596367

DOI: 10.1186/s12871-015-0111-z
PubMed: 26444853
PubMed Central: 4596367

Affiliations:

Le document en format XML

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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Test ventilating prior to administration of neuromuscular blockade (NMB) in order to avoid a cannot intubate-cannot ventilate situation is a classic anesthesia teaching. The primary aim of our study was to show that facemask ventilation (FMV) after NMB was not inferior to FMV prior to NMB with respect to exhaled gas volumes before and after their administration.</p>
</sec>
<sec><title>Methods</title>
<p>This study was approved by the University of Washington Human Subjects Division (Seattle, Washington, USA). Written informed consent was obtained from all patients. Measurements of tidal volume (Vte) as well as other respiratory parameters during FMV were made for 60 s after induction of anesthesia and again after NMB. Difficult, impossible, inadequate, and dead-space only mask ventilation was graded using published definitions. Difficult intubation was defined as >2 attempts at intubation. The primary outcome was non-inferiority in Vte during both study periods defined as a mean difference of <50 mL. Multivariate analysis was performed to assess for interaction between operator experience, patient risk factors for difficult mask ventilation, exhaled volumes, and use of airway adjuncts.</p>
</sec>
<sec><title>Results</title>
<p>Two-hundred and ten patients were studied. Overall, FMV improved after NMBD. The mean (SD) V<sub>te</sub>
 in mL/breath increased from 399 (169) to 428 (166) (mean dif. 30 mL, <italic>p</italic>
 = 0.001) and the minute ventilation in L/min from 5.6 (2.5) to 6.3 (2.5) (mean dif. 0.6, <italic>p</italic>
 < 0.001). No patient who was difficult to ventilate after induction became impossible after NMB.</p>
</sec>
<sec><title>Discussion</title>
<p>In patients at risk for or judged to be a difficult FMV by clinical grading scales, tidal volumes improved after administration of NMBDs. None of these patients exhibited a decline in ventilation or became impossible to ventilate after NMBDs. Several limitations are noted, including the use of hand-delivered breaths and inability to account for time-related changes in ventilation conditions independent of NMBDs.</p>
</sec>
<sec><title>Conclusion</title>
<p>We conclude that FMV is no worse after NMB than before and is likely to improve airway conditions.</p>
</sec>
<sec><title>Trial Registration</title>
<p>ClinicalTrials.gov Identifier: <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT02237443">NCT02237443</ext-link>
. Registered August 28, 2014</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s12871-015-0111-z) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
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Ventilation by mask before and after the administration of neuromuscular blockade: a pragmatic non-inferiority trial

Ventilation by mask before and after the administration of neuromuscular blockade: a pragmatic non-inferiority trial

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Abstract

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	Serveur d'exploration sur le patient édenté
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