Comparison of Two-hand Mask Ventilation Technique: Standard V-E Versus Reversal V-E Technique

Study Overview
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Brief Summary
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This study hypothesizes that a novel reversal V-E ventilation technique will retain its high efficiency as that of standard V-E technique and will be easier to use.

Detailed Description
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Despite advances in intubation technology, difficult airways persist. Because it is failure to oxygenate, not failure to intubate, that ultimately leads to brain injury and cardiovascular collapse, effective mask ventilation is at least as important as successful intubation. Therefore optimizing mask ventilation is crucial for clinicians. When difficult mask ventilation encounters, clinicians often switch to two hand technique to hold the mask including either C-E clamp or V-E clamp. Both volume mode ventilation and pressure mode ventilation are superior with the V-E technique as compared to the C-E technique. The study will test the hypothesis that a novel reversal V-E mask ventilation technique will retain its high efficiency as that of standard V-E technique but be easier to use than standard V-E technique.

Official Title
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Comparison of Two-hand Mask Ventilation Technique: Standard V-E Versus Reversal V-E Technique

Conditions
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Intubation

Intervention / Treatment
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* Procedure: Standard V-E ventilation technique
* Procedure: Reversal V-E ventilation technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over 18 years of age Requiring general anesthesia BMI =>30 Exclusion Criteria: Untreated ischemic heart diseases Respiratory disorders, including COPD and asthma American Society of Anesthesiologists(ASA) physical class of 4 or greater Undergoing emergency surgery Requiring rapid sequence intubation for aspiration protection Non propofol - induction of anesthesia Requiring fiberoptic intubation Pregnant women or women who have given birth within the last month

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Single Group Assignment
Interventional Model Description: Comparison of 2 two-handed mask ventilation techniques' ease to anesthesia providers
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard V-E ventilation technique<br>After induction of anesthesia subject will be ventilated using the standard V-E ventilation technique. Ventilation will be carried out using pressure mode ventilation at respiratory rate of 10 breaths per minute, I:E ratio of 1:2, peak inspiratory pressure of 20cmH2O and no PEEP. If the subjects can be adequately ventilated, as defined by perceivable chest movement and end tidal CO2 during the first three breaths, ventilation will continue for total ten breaths. | Procedure: Standard V-E ventilation technique<br>* For the two-handed standard V-E technique, the facemask is first placed over the bridge of the nose and mouth and then held in place by performing at two-handed jaw thrust maneuver with the index and second finger of each hand and maintaining mask contact with the patient's face by using both thumbs with mouth open. A head-tilt is performed by applying a caudal force on the mandible and mask.<br>|
| Experimental: Reversal V-E ventilation technique<br>After induction of anesthesia subject will be ventilated using the reversal V-E ventilation technique. Ventilation will be carried out using pressure mode ventilation at respiratory rate of 10 breaths per minute, I:E ratio of 1:2, peak inspiratory pressure of 20cmH2O and no PEEP. If the subjects can be adequately ventilated, as defined by perceivable chest movement and end tidal CO2 during the first three breaths, ventilation will continue for total ten breaths. | Procedure: Reversal V-E ventilation technique<br>* While using reversal V-E technique, the anesthesia provider stands 180 degrees opposite from the head of the bed. Thenar eminence and thumbs secure the mask around the nose while the remaining fingers pull the mandible anteriorly while keeping the mouth open.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual score of friendliness of mask holding technique using 11 point scale | Visual score of friendliness of mask holding technique using 11 point scale when 0 is easy and 10 is difficult. | Conclusion of masked ventilation (approximately 5 minutes) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| AUC of exhaled tidal volume (Vt) trace | Comparison of AUC of exhaled tidal volume trace | Period of masked ventilation (approximately 5 minutes) | 
| Vt/AUC | Vt/AUC of exhaled Vt | Period of masked ventilation (approximately 5 minutes) | 
| Peak inspiratory airway pressure | Peak inspiratory airway pressure | Period of masked ventilation (approximately 5 minutes) |