El-Orbany Mohammad, Woehlck Harvey J
Department of Anesthesiology-West, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA.
Anesth Analg. 2009 Dec;109(6):1870-80. doi: 10.1213/ANE.0b013e3181b5881c.
Mask ventilation is the most fundamental skill in airway management. In this review, we summarize the current knowledge about difficult mask ventilation (DMV) situations. Various definitions for DMV have been used in the literature. The lack of a precise standard definition creates a problem for studies on DMV and causes confusion in data communication and comparisons. DMV develops because of multiple factors that are technique related and/or airway related. Frequently, the pathogenesis involves a combination of these factors interacting to cause the final clinical picture. The reported incidence of DMV varies widely (from 0.08% to 15%) depending on the criteria used for its definition. Obesity, age older than 55 yr, history of snoring, lack of teeth, the presence of a beard, Mallampati Class III or IV, and abnormal mandibular protrusion test are all independent predictors of DMV. These signs should, therefore, be recognized and documented during the preoperative evaluation. DMV can be even more challenging in infants and children, because they develop hypoxemia much faster than adults. Finally, difficult tracheal intubation is more frequent in patients who experience DMV, and thus, clinicians should be familiar with the corrective measures and management options when faced with a challenging, difficult, or impossible mask ventilation situation.
面罩通气是气道管理中最基本的技能。在本综述中，我们总结了当前关于困难面罩通气（DMV）情况的知识。文献中使用了各种DMV的定义。缺乏精确的标准定义给DMV的研究带来了问题，并导致数据交流和比较中的混乱。DMV的发生是由多种与技术相关和/或与气道相关的因素引起的。通常，发病机制涉及这些因素的相互作用，共同导致最终的临床表现。根据定义DMV所使用的标准不同，报道的DMV发生率差异很大（从0.08%到15%）。肥胖、年龄大于55岁、打鼾史、无牙、有胡须、MallampatiⅢ或Ⅳ级以及下颌前突试验异常都是DMV的独立预测因素。因此，在术前评估期间应识别并记录这些体征。DMV在婴儿和儿童中可能更具挑战性，因为他们比成人更快出现低氧血症。最后，经历DMV的患者更常出现困难气管插管，因此，临床医生在面对具有挑战性、困难或无法进行面罩通气的情况时，应熟悉纠正措施和管理选择。
