Liang Yafen, Kimball William R, Kacmarek Robert M, Zapol Warren M, Jiang Yandong
Department of Anesthesia and Critical Care, MassachusettsGeneral Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
Anesthesiology. 2008 Jun;108(6):998-1003. doi: 10.1097/ALN.0b013e318174f027.
The authors hypothesized that nasal mask ventilation may be more effective than combined oral-nasal mask ventilation during induction of general anesthesia. They tested this hypothesis by comparing the volume of carbon dioxide removed per breath with nasal versus combined oral-nasal mask ventilation in nonparalyzed, apneic, adult subjects during induction of general anesthesia.
Fifteen adult subjects receiving general anesthesia were ventilated first with a combined oral-nasal mask and then with only a nasal mask. The patient's head was maintained in a neutral position, without head extension or lower jaw thrust. Respiratory parameters were recorded simultaneously from both the nasal and oral masks regardless of ventilation approach.
The volume of carbon dioxide removed per breath during nasal mask ventilation (median, 5.0 ml; interquartile range, 3.4-8.8 ml) was significantly larger than that during combined oral-nasal mask ventilation (median, 0.0 ml; interquartile range, 0.0-0.4 ml; P = 0.001); even the peak inspiratory airway pressure during nasal ventilation (16.7 +/- 2.7 cm H2O) was lower than that during combined oral-nasal ventilation (24.5 +/- 4.7 cm H2O; P = 0.002). The expiratory tidal volume during nasal ventilation (259.8 +/- 134.2 ml) was also larger than that during combined oral-nasal ventilation (98.9 +/- 103.4 ml; P = 0.003).
Nasal mask ventilation was more effective than combined oral-nasal mask ventilation in apneic, nonparalyzed, adult subjects during induction of general anesthesia. The authors suggest that nasal mask ventilation, rather than full facemask ventilation, be considered during induction of anesthesia.
作者推测在全身麻醉诱导期间，鼻面罩通气可能比口鼻联合面罩通气更有效。他们通过比较在全身麻醉诱导期间，非麻痹、无呼吸的成年受试者使用鼻面罩通气与口鼻联合面罩通气时每呼吸周期呼出的二氧化碳量来验证这一假设。
15名接受全身麻醉的成年受试者先使用口鼻联合面罩通气，然后仅使用鼻面罩通气。患者头部保持中立位，不进行头部后仰或下颌前推。无论采用何种通气方式，均同时记录鼻面罩和口鼻联合面罩的呼吸参数。
鼻面罩通气时每呼吸周期呼出的二氧化碳量（中位数为5.0 ml；四分位间距为3.4 - 8.8 ml）显著大于口鼻联合面罩通气时（中位数为0.0 ml；四分位间距为0.0 - 0.4 ml；P = 0.001）；甚至鼻通气时的吸气峰压（16.7±2.7 cm H₂O）也低于口鼻联合通气时（24.5±4.7 cm H₂O；P = 0.002）。鼻通气时的呼气潮气量（259.8±134.2 ml）也大于口鼻联合通气时（98.9±103.4 ml；P = 0.003）。
在全身麻醉诱导期间，对于无呼吸、非麻痹的成年受试者，鼻面罩通气比口鼻联合面罩通气更有效。作者建议在麻醉诱导期间应考虑使用鼻面罩通气，而非全面罩通气。
