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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard V-E ventilation technique | Active Comparator | 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. |
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| Reversal V-E ventilation technique | Experimental | 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. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard V-E ventilation technique | Procedure | 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. |
| 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) |
| 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 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Christopher Canlas, M.D. | Vanderbilt University Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Vanderbilt University Medical Center | Nashville | Tennessee | 37212 | United States |
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Comparison of 2 two-handed mask ventilation techniques' ease to anesthesia providers
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| Reversal V-E ventilation technique | Procedure | 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. |
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| Period of masked ventilation (approximately 5 minutes) |
| Peak inspiratory airway pressure | Peak inspiratory airway pressure | Period of masked ventilation (approximately 5 minutes) |