Effect of Head Rotation on Efficacy of Face Mask Ventilation in Anesthetized Obese (BMI ≥ 35) Adults
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/20/2019 |
| Start Date: | April 2019 |
| End Date: | April 2021 |
| Contact: | Boris Mraovic, MD |
| Email: | mraovicb@health.missouri.edu |
| Phone: | 573-882-2568 |
A Prospective, Randomized, Non-Blinded, Crossover Controlled Clinical Trial Evaluating the Efficacy of Face Mask Ventilation With 45 Degree Head Rotation in Anesthetized Obese (BMI ≥ 35) Adults
Mask ventilation is fundamental to airway management at the start of surgical procedures
requiring general anesthesia. For general anesthesia, medications are provided that affect
the entire body and lead to a loss of consciousness. Medical professionals perform mask
ventilation by placing a plastic mask over a subjects mouth and nose to provide enough oxygen
for the placement of a breathing tube. In this study, we expect that a 45 degree rotation of
the head will increase the efficiency of mask ventilation.
requiring general anesthesia. For general anesthesia, medications are provided that affect
the entire body and lead to a loss of consciousness. Medical professionals perform mask
ventilation by placing a plastic mask over a subjects mouth and nose to provide enough oxygen
for the placement of a breathing tube. In this study, we expect that a 45 degree rotation of
the head will increase the efficiency of mask ventilation.
Mask ventilation is a foundation of airway management after the initial induction of
anesthesia. It allows for adequate oxygenation of the patient to buy enough time for
intubation, during which the patient is not ventilated. However, in some patients mask
ventilation may be difficult - older than 55 years, heavier (BMI > 26 kg/m^2), with no teeth,
having a beard or sleep apnea. Inadequate ventilation, if not corrected, can result in
decreasing oxygen saturation to dangerous levels - which could lead to devastating
complications. As a result, the efficacy of mask ventilation is of critical importance to
patient safety after the induction of anesthesia.
A recent study proposed that mask ventilation could be improved simply by turning a patient's
head. The study showed that rotating a patient's head to a 45 degree angle significantly
improved mask ventilation when compared with the head placed in a neutral position. However,
this study was done in patients with a BMI lass than 35. As such, the effects of head
rotation on the efficacy of mask ventilation has not been studied in patients with a BMI of
35 and greater.
Obesity (BMI ≥ 30 kg/m^2) affects almost 40% of US adults and is one of the most prevalent
health concerns in our society. It is a predictor of difficult mask ventilation because it is
associated with increased upper airway obstruction, decreased airway patency, and decreased
lung volumes such as functional residual capacity (FRC). If previous findings in regard to
the effects of 45 degree head rotation on the efficacy of ventilation hold true in the obese
patient, then this study will show that head rotation could be used as a simple way to
improve the efficacy of mask ventilation for patients with a BMI of 35 and above.
anesthesia. It allows for adequate oxygenation of the patient to buy enough time for
intubation, during which the patient is not ventilated. However, in some patients mask
ventilation may be difficult - older than 55 years, heavier (BMI > 26 kg/m^2), with no teeth,
having a beard or sleep apnea. Inadequate ventilation, if not corrected, can result in
decreasing oxygen saturation to dangerous levels - which could lead to devastating
complications. As a result, the efficacy of mask ventilation is of critical importance to
patient safety after the induction of anesthesia.
A recent study proposed that mask ventilation could be improved simply by turning a patient's
head. The study showed that rotating a patient's head to a 45 degree angle significantly
improved mask ventilation when compared with the head placed in a neutral position. However,
this study was done in patients with a BMI lass than 35. As such, the effects of head
rotation on the efficacy of mask ventilation has not been studied in patients with a BMI of
35 and greater.
Obesity (BMI ≥ 30 kg/m^2) affects almost 40% of US adults and is one of the most prevalent
health concerns in our society. It is a predictor of difficult mask ventilation because it is
associated with increased upper airway obstruction, decreased airway patency, and decreased
lung volumes such as functional residual capacity (FRC). If previous findings in regard to
the effects of 45 degree head rotation on the efficacy of ventilation hold true in the obese
patient, then this study will show that head rotation could be used as a simple way to
improve the efficacy of mask ventilation for patients with a BMI of 35 and above.
Inclusion Criteria:
- Age ≥ 18 years
- ASA Physical Status Classification I-III
- Body Mass Index (BMI) ≥ 35 kg/m^2
Exclusion Criteria:
- Inability to obtain written informed consent
- Pregnant or breastfeeding
- Limited head rotation or neck extension
- Subjects with expected or history difficult intubation
- Large beard
- Orogastric (OG)/nasogastric (NG) tube
- Gastroesophageal Reflux Disease (GERD)
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