title: Mechanical versus manual ventilation via a face mask during the induction of anesthesia: a prospective, randomized, crossover study.
abstract: One approach to make ventilation safer in an unprotected airway has been to limit tidal volumes; another one might be to limit peak airway pressure, although it is unknown whether adequate tidal volumes can be delivered. Accordingly, the purpose of this study was to evaluate the quality of automatic pressure-controlled ventilation versus manual circle system face-mask ventilation regarding ventilatory variables in an unprotected airway. We studied 41 adults (ASA status I-II) in a prospective, randomized, crossover design with both devices during the induction of anesthesia. Respiratory variables were measured with a pulmonary monitor (CP-100). Pressure-controlled mask ventilation versus circle system ventilation resulted in lower (mean +/- SD) peak airway pressures (10.6 +/- 1.5 cm H(2)O versus 14.4 +/- 2.4 cm H(2)O; P < 0.001), delta airway pressures (8.5 +/- 1.5 cm H(2)O versus 11.9 +/- 2.3 cm H(2)O; P < 0.001), expiratory tidal volume (650 +/- 100 mL versus 680 +/- 100 mL; P = 0.001), minute ventilation (10.4 +/- 1.8 L/min versus 11.6 +/- 1.8 L/min; P < 0.001), and peak inspiratory flow rates (0.81 +/- 0.06 L/s versus 1.06 +/- 0.26 L/s; P < 0.001) but higher inspiratory time fraction (48% +/- 0.8% versus 33% +/- 7.7%; P < 0.001) and end-tidal carbon dioxide (34 +/- 3 mm Hg versus 33 +/- 4 mm Hg; not significant). We conclude that in this model of apneic patients with an unprotected airway, pressure-controlled ventilation resulted in reduced inspiratory peak flow rates and peak airway pressures when compared with circle system ventilation, thus providing an additional patient safety effect during mask ventilation.
  
  
  CONCLUSIONS
  In this model of apneic patients with an unprotected airway, pressure-controlled ventilation resulted in reduced inspiratory peak flow rates and lower peak airway pressures when compared with circle system ventilation, thus providing an additional patient safety effect during face-mask ventilation.
authors.affiliation: *Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria; and †Department of Anesthesiology and Intensive Care Medicine, University Hospital of Kiel, Kiel, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: von Goedecke
authors.forename: Wolfgang G
authors.initials: WG
authors.lastname: Voelckel
authors.forename: Volker
authors.initials: V
authors.lastname: Wenzel
authors.forename: Christoph
authors.initials: C
authors.lastname: Hörmann
authors.forename: Horst G
authors.initials: HG
authors.lastname: Wagner-Berger
authors.forename: Volker
authors.initials: V
authors.lastname: Dörges
authors.forename: Karl H
authors.initials: KH
authors.lastname: Lindner
authors.forename: Christian
authors.initials: C
authors.lastname: Keller
mesh_terms: D000293:Adolescent; D000328:Adult; D000769:Anesthesia, Inhalation; D001049:Apnea / Q000628:therapy; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009141:Musculoskeletal System / Q000601:surgery; D011446:Prospective Studies; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000502:physiology