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Mask Ventilation (mask + ventilation)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Mask ventilation with esophageal intubation

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2001
Mustafa H. Joda
First page of article [source]

Neopuff T-piece mask resuscitator: is mask leak related to watching the pressure dial?

ACTA PAEDIATRICA, Issue 9 2010
MB Tracy
Abstract Aim:, The aim of the study is to compare mask leak and delivered ventilation during Neopuff (NP) mask ventilation in two modes: (i) with NP pressure dial hidden and resuscitator watching chest wall (CW) rise with, (ii) CW movement hidden and resuscitator watching NP pressure dial. Methods:, Thirty-six participants gave mask ventilation to a modified manikin designed to measure mask leak and delivered ventilation for two minutes in each mode randomly assigned. Paired t -tests were used to analyse differences in mean values. Linear regression was used to determine the association of mask leak with delivered ventilation. Results:, Of 7277 inflations analysed, 3621 were observing chest wall mode (CWM) and 3656 observing NP mode (NPM). Mask leak was similar between the groups; 31.6% for CWM and 31.5% (p = 0.56) for NPM. There were no significant differences in airways pressures and expired tidal volumes (TVe) between modes. Mask leak was strongly associated with TVe (R = ,0.86 p < 0.0001) and with peak inspiratory pressure (PIP) (R = ,0.51 p < 0.0001). TVe was associated with PIP (R = 0.51 p < 0.0001). Conclusion:, This study provides reassurance that NP mask leak is not greater when resuscitators watch the NP pressure dial. Mask leak is related to TVe. Mask ventilation training with manikins should include tidal volume measurements. [source]

Comparison of desaturation and resaturation response times between transmission and reflectance pulse oximeters

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010
S. J. CHOI
Background: In general, there is a response time between actual arterial hypoxemia and its detection by pulse oximeters. We compared the desaturation and resaturation response times between two types of pulse oximeters, transmission and reflectance pulse oximeters, to find out which oximeter has a more rapid response time. Methods: Thirty-three ASA 1 or 2 patients were enrolled in this study. A transmission pulse oximeter was placed on the index finger and a reflectance pulse oximeter was placed on the forehead and monitored simultaneously. After the induction of general anesthesia without pre-oxygenation, we waited until the oxygen saturation value of any of two pulse oximeters declined to 90%, and then mask ventilation was started with 100% oxygen. Oxygen saturation was recorded at an interval of 2 s during this time. Results: The desaturation response time of SpO2 to 95% after apnea was 82.0 s (interquartile range: 67.0,98.5 s) vs. 94.0 s (interquartile range: 84.0,106.5 s) (P<0.001) and SpO2 to 90% was 94.0 s (interquartile range: 75.5,109.5 s) vs. 100.0 s (interquartile range: 84.5,114.5 s) (P<0.001) in the reflectance and transmission oximeters, respectively. The resaturation response time from mask ventilation to 100% SpO2 was 23.2±5.6 vs. 28.9±7.6 s (P<0.001) in the reflectance and transmission oximeters, respectively. Conclusion: In clinical situations in which rapid changes in oxygen saturation are expected, we recommend the forehead reflectance pulse oximeter because it responds more quickly in detecting oxygen desaturation and resaturation compared with the transmission pulse oximeter. [source]

A controlled rapid-sequence induction technique for infants may reduce unsafe actions and stress

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009
C. EICH
Background: Classic rapid-sequence induction of anaesthesia (RSI-classic) in infants and small children presents a time-critical procedure, regularly associated with hypoxia. This results in high stress levels for the provider and may trigger unsafe actions. Hence, a controlled induction technique (RSI-controlled) that involves gentle mask ventilation until full non-depolarizing muscular blockade has become increasingly popular. Clinical observation suggests that RSI-controlled may reduce the adverse effects noted above. We aimed to evaluate both techniques with respect to unsafe actions and stress. Methods: In this controlled, randomized simulator-based study, 30 male trainees and specialists in anaesthesiology performed a simulated anaesthesia induction in a 4-week-old infant with pyloric stenosis. Two different RSI techniques, classic and controlled, were applied to 15 candidates each. We recorded the incidence of hypoxaemia, forced mask ventilation, and intubation difficulties. In addition, we measured individual stress levels by ergospirometry, salivary cortisol, and ,-amylase, as well as a post-trial questionnaire. Results: Hypoxaemia always occurred in RSI-classic but not in RSI-controlled, repeatedly resulting in unsafe actions. Subjective stress perception and some objective stress levels were lower in the volunteers performing RSI-controlled. Conclusions: Our data suggest that RSI-controlled, as compared with RSI-classic, leads to fewer unsafe actions and may reduce individual stress levels. [source]

Paediatric airway management: basic aspects

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009
R. J. HOLM-KNUDSEN
Paediatric airway management is a great challenge, especially for anaesthesiologists working in departments with a low number of paediatric surgical procedures. The paediatric airway is substantially different from the adult airway and obstruction leads to rapid desaturation in infants and small children. This paper aims at providing the non-paediatric anaesthesiologist with a set of safe and simple principles for basic paediatric airway management. In contrast to adults, most children with difficult airways are recognised before induction of anaesthesia but problems may arise in all children. Airway obstruction can be avoided by paying close attention to the positioning of the head of the child and by keeping the mouth of the child open during mask ventilation. The use of oral and nasopharyngeal airways, laryngeal mask airways, and cuffed endotracheal tubes is discussed with special reference to the circumstances in infants. A slightly different technique during laryngoscopy is suggested. The treatment of airway oedema and laryngospasm is described. [source]

The impact of a new educational strategy on acquiring neonatology skills

MEDICAL EDUCATION, Issue 5 2002
I Treadwell
Overview A shortage of staff for teaching neonatology skills to large numbers of students, in small groups and following a new curriculum, necessitated an innovative educational strategy. This entailed the development and implementation of an interactive multimedia program (CD-ROM) to deliver information about skills and to demonstrate them. Methods Students had to study a specific skill using the CD-ROM and then practise in the Skills Laboratory, supported by lecturers who provided formative evaluation. Objectives The aims of this study were to assess the students' perspectives on the new strategy, and to compare the skills of students following the new curriculum to those of students following the traditional curriculum, who do not follow structured programmes on practical skills but experience a practical neonatology rotation. Results The evaluation of the CD-ROM program was very favourable. The majority of students still preferred live demonstrations but found the CD-ROM useful for revision purposes. With the exception of one skill, endotracheal intubation, the new curriculum students were found to be as competent as the students following the traditional curriculum and performed mask ventilation and cardiac massage significantly better than them. [source]

Probability of acceptable intubation conditions with low dose rocuronium during light sevoflurane anaesthesia in children

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2001
M. Eikermann
Background: To define the rocuronium doses which would provide 50%, 90%, and 95% probability of ,acceptable' intubation conditions during light sevoflurane anaesthesia, we studied 60 children aged 2,7 years in a prospective, randomised, assessor blinded study. Methods: After mask ventilation with 1 MAC sevoflurane/N2O for 17±1 (x̌±SD) min we administered rocuronium (either 0.15, 0.22, 0.3, 0.5, or 1.0 mg ,· ,kg,1) or placebo, and quantified the evoked force of the adductor pollicis muscle. Intubation conditions were assessed before and 2 min after injection of the test drug. Results: Intubation conditions were improved significantly with rocuronium and scored ,acceptable' in 70%, 90%, and 100% of the children after injection of rocuronium 0.15, 0.22, and 0.3 mg ,· ,kg,1, respectively. In parallel, twitch tension decreased to 53% (6,100), 26% (11,100), and 11% (0,19) of baseline (median (range)). Recovery of train-of-four ratio to 0.8 was achieved 13 (7,19), 16 (8,28), and 27 (23,44) min after injection of the respective rocuronium doses. Higher rocuronium doses did not further improve intubation conditions but only prolonged time of neuromuscular recovery. Logistic regression analysis revealed that rocuronium 0.11 (CI 0.05,0.16), 0.21 (0.14,0.28), and 0.25 (0.15,0.34) mg ,· ,kg,1 provides a 50%, 90%, and 95% probability of ,acceptable' intubation conditions in children during 1 MAC sevoflurane/N2O anaesthesia, respectively. Furthermore, we calculated that force depression of adductor pollicis muscle to 81% (CI 72,90), 58% (42,74), and 50% (29,71) of baseline is associated with 50%, 90%, and 95% probability of ,acceptable' intubation conditions. Conclusions: Submaximal depression of muscle force with low dose rocuronium improves intubation conditions in children during light sevoflurane anaesthesia while allowing rapid recovery of neuromuscular function. However, when using low dose rocuronium neuromuscular monitoring may be helpful to detect children with inadequate response to the relaxant so as to avoid an unsuccessful intubation attempt. [source]

Epydermolysis bullosa: a new technique for mask ventilation

PEDIATRIC ANESTHESIA, Issue 11 2008
Salvatore Meola
No abstract is available for this article. [source]

A response to ,The effect of neuromuscular blockade on the efficiency of mask ventilation of the lungs', Goodwin MWP et al., Anaesthesia 2003; 58: 60,2.

ANAESTHESIA, Issue 6 2003
C. Cumming
No abstract is available for this article. [source]

Basic Emergency Medicine Skills Workshop as the Introduction to the Medical School Clinical Skills Curriculum

ACADEMIC EMERGENCY MEDICINE, Issue 2009
Wallace Carter
Introduction:,Most medical school curricula lack training in basic skills needed in a medical emergency. After the September 11th, 2001 terrorist attacks, junior level medical students at our institution volunteered their time in the emergency department[ or at Ground Zero. They quickly realized they had little or no practical training for an emergency situation. Objectives:,To correct this curriculum deficit, a five hour basic emergency medicine skills / first responder course for students in their first few weeks of medical school was designed. Methods:,The course consists of lectures followed by related skills stations. Lectures include an introduction to the first responder concept, basic airway, breathing, and circulation management, and a rapid, systematic approach to common emergencies. Skills stations teach basic airway management, bag valve mask ventilation, splinting and immobilizing, and moving patients in the field, stressing improvisation. Multiple skills are practiced in a final simulation station using actors with wound moulage and scripted scenarios. Results:,This course, instituted at Weill Cornell Medical School in 2002, has become a mainstay of the first year curriculum. Student evaluations have been uniformly superlative. There is strong student sentiment that this is the most practical course of the first year. Conclusion:,After six years of experience, we have shown it is possible to present a truncated first responder course as part of the first year curriculum. The course generates tremendous interest and awareness regarding emergency medicine. Future research will examine whether skills taught in this course are retained and can be correctly applied later in medical school. [source]

Pediatric Resuscitation Mock Code Practice Impacts Selected Skills

ACADEMIC EMERGENCY MEDICINE, Issue 2008
Jennifer Mackey
Objectives:, Determine the utility of a computer-controlled mannequin in training and assessment of resident pediatric resuscitation skills. Determine if mock code practice is beneficial in maintaining mastery of critical pediatric resuscitation skills. Methods:, A prospective randomized study of 22 interns (12 pediatric, 10 emergency medicine) randomized to: Group 1 (cases who participated in 3 mock codes over a 6 month period) and Group 2 (controls who did not receive mock code practice). Each intern was randomly paired in teams of two who participated at baseline in two code scenarios using the Laerdal Simbaby. The interns alternated airway and circulatory management responsibility. At 6 months all interns returned to the simulator in pairs to participate in another two pediatric code scenarios. All sessions were videotaped and time of computer initiation of scenario events recorded. Videos were examined by a pediatric emergency physician (blinded to Group participation) using a structured recording form. A general linear model was used to assess differences in response times and Fisher's exact tests for categorical data. Results:, Whether in charge of airway or circulatory management, at post test interns who had completed mock codes required less time to: recognize the need for bag mask ventilation (Diff 5.6 seconds, p < 0.005), initiate BVM (Diff 2.7 seconds, p < 0.006), intubate (Diff 22 seconds, p < 0.03), and recognizing the need for chest compressions (Diff 24 seconds, p < 0.03). There were no differences in times for recognizing the need for fluid resuscitation or for factors such as appropriate mask size, rate of ventilation, intubation success (including number of attempts), compression techniques, or IO placement. Conclusions:, Computer controlled mannequins provide reproducible measurable experiences. This study demonstrates that mock code practice may impact some, but not all, aspects of pediatric resuscitation skill retention. [source]

Neopuff T-piece mask resuscitator: is mask leak related to watching the pressure dial?

Effect of perinatal asphyxia on thyroid-stimulating hormone and thyroid hormone levels

ACTA PAEDIATRICA, Issue 3 2003
DN Pereira
Aim: To compare serum concentrations of thyroid hormones,T4, T3, free T4 (FT4) and reverse T3 (rT3),and thyroid-stimulating hormone (TSH) found in the umbilical cord blood of term newborns with and without asphyxia and those found in their arterial blood collected between 18 and 24 h after birth. A further aim of the study was to assess the association between severity of hypoxic-ischemic encephalopathy and altered thyroid hormone and TSH levels, and between mortality and FT4 levels in the arterial blood of newborns between 18 and 24 h of life. Methods: A case-control study was carried out. The case group comprised 17 term newborns (Apgar score ,3 and ,5 at the first and fifth minutes; umbilical cord blood pH ,7.15) who required bag and mask ventilation for at least one minute immediately after birth. The control group consisted of 17 normal, term newborns (Apgar score ,8 and ,9 at the first and fifth minutes; umbilical cord blood pH ,7.2). Cord blood and arterial blood samples were collected immediately after birth and 18 to 24 h after birth, respectively, and were used in the blood gas analysis and to determine serum concentrations of T4, T3, FT4, rT3 and TSH by radioimmunoassay. All newborns were followed-up until hospital discharge or death. Results: Gestational age, birthweight, sex, size for gestational age, mode of delivery and skin color (white and non-white) were similar for both groups. No differences were found in mean levels of cord blood TSH, T4, T3 and FT4 between the groups. In the samples collected 18 to 24 h after birth, mean levels of TSH, T4, T3 and FT4 were significantly lower in the asphyxiated group than in the control group. Mean concentrations of arterial TSH, T4 and T3 between 18 and 24 h of life were lower than concentrations found in the cord blood analysis in asphyxiated newborns, but not in controls. In addition, asphyxiated newborns with moderate/severe hypoxic-ischemic encephalopathy presented significantly lower mean levels of TSH, T4, T3 and FT4 than those of controls. None of the asphyxiated newborns with FT4 ,2.0 ng/dl died; 6 out of the 11 asphyxiated newborns with FT4 < 2.0 ng/dl died. Conclusions: Serum concentrations of TSH, T4, T3 and FT4 are lower in asphyxiated newborns than in normal newborns between 18 and 24 h of life; this suggests central hypothyroidism secondary to asphyxia. Asphyxiated newborns with moderate/severe hypoxic-ischemic encephalopathy present a greater involvement of the thyroid function and consequently a greater risk of death. [source]