The effect of neuromuscular blockade on mask ventilation.
We wished to test the hypothesis that neuromuscular blockade facilitates mask ventilation. In order reliably and reproducibly to assess the efficiency of mask ventilation, we developed a novel grading scale (Warters scale), based on attempts to generate a standardised tidal volume. Following induction of general anaesthesia, a blinded anaesthesia provider assessed mask ventilation in 90 patients using our novel grading scale. The non-blinded anaesthesiologist then randomly administered rocuronium or normal saline. After 2 min, mask ventilation was reassessed by the blinded practitioner. Rocuronium significantly improved ventilation scores on the Warters scale (mean (SD) 2.3 (1.6) vs 1.2 (0.9), p<0.001). In a subgroup of patients with a baseline Warters scale value of >3 (i.e. difficult to mask ventilate; n=14), the ventilation scores also showed significant improvement (4.2 (1.2) vs 1.9 (1.0), p=0.0002). Saline administration had no effect on ventilation scores. Our data indicate that neuromuscular blockade facilitates mask ventilation. We discuss the implications of this finding for unexpected difficult airway management and for the practice of confirming adequate mask ventilation before the administration of neuromuscular blockade.
Department of Anesthesia and Perioperative Medicine, Division of Cardiothoracic Surgery and Anesthesia, Medical University of South Carolina, Charleston, SC, USA.
R D
RD
Warters
T A
TA
Szabo
F G
FG
Spinale
S M
SM
DeSantis
J G
JG
Reves
D000368:Aged; D000732:Androstanols / Q000494:pharmacology; D000768:Anesthesia, General / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008397:Masks; D008875:Middle Aged; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology; D012121:Respiration, Artificial / Q000379:methods*; D000077123:Rocuronium; D016037:Single-Blind Method; D013990:Tidal Volume / Q000187:drug effects
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium