Department of Anaesthesia, Royal Free Hospital London, Hampstead, UK.
Br J Anaesth. 2010 Mar;104(3):313-7. doi: 10.1093/bja/aep380. Epub 2009 Dec 30.
Our aim was to determine whether anaesthetists routinely confirm their ability to ventilate a patient's lungs by a facemask before the administration of a neuromuscular blocker and the rationale for this practice.
An online survey of trainee and non-trainee anaesthetists working in hospitals forming part of the Central London School of Anaesthesia collected 136 complete data sets over a 3 month period.
Seventy-eight of 136 (57%) routinely checked they could ventilate by the facemask ('checkers'). The reasons given for this varied, though the most common was the ability to 'enable escape wake-up'. The practice was most commonly adopted by anaesthetists with less experience. In a hypothetical 'cannot ventilate' scenario, the use of succinylcholine was advocated by the majority of respondents, both 'checkers' and 'non-checkers'.
Despite the lack of firm evidence to support the practice of confirming the ability to ventilate the lungs before administering a neuromuscular blocking drug (NMB), we found strongly held views that supported the practice and equally strongly held views that opposed it. However, in a hypothetical emergency situation where ventilation by the facemask after induction of anaesthesia was impossible, the majority of respondents (including 'checkers') would administer a neuromuscular blocker. This apparent paradox can be explained by well-recognized psychological mechanisms. We suggest that in checking the ability to ventilate by the facemask, some anaesthetists are seeking information that may be relevant but not instrumental in deciding when to administer an NMB.
我们旨在确定麻醉师在给予神经肌肉阻滞剂之前是否例行确认其通过面罩给患者通气的能力，以及该做法的原理。
在一项针对在伦敦中部麻醉学院所属医院工作的受训和非受训麻醉师的在线调查中，在 3 个月的时间内收集了 136 份完整数据。
136 名参与者中，78 名（57%）例行确认通过面罩通气的能力（“确认者”）。给出的理由各不相同，但最常见的是能够“实现苏醒逃逸”。这种做法最常被经验较少的麻醉师采用。在假设的“无法通气”情况下，大多数受访者（包括“确认者”和“非确认者”）都主张使用琥珀酰胆碱。
尽管缺乏确凿证据支持在给予神经肌肉阻滞剂之前确认通气能力的做法，但我们发现有强烈支持和反对该做法的观点。然而，在诱导麻醉后通过面罩通气的假设紧急情况下，大多数受访者（包括“确认者”）将使用神经肌肉阻滞剂。这种明显的悖论可以用公认的心理机制来解释。我们认为，在通过面罩检查通气能力时，一些麻醉师正在寻找可能相关但对决定何时给予神经肌肉阻滞剂无实际作用的信息。
