Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686, Japan.
Can J Anaesth. 2017 Sep;64(9):935-939. doi: 10.1007/s12630-017-0911-3. Epub 2017 Jun 16.
Previous studies have shown that the nasal passage plays an important role in manual face mask ventilation, but this has yet to be quantitatively assessed. We conducted a prospective randomized crossover clinical trial to compare the change in pressure-controlled face mask tidal volume with and without nasal airway occlusion.
Female patients undergoing elective surgery under general anesthesia served as study subjects. Patients were randomly assigned to face mask ventilation beginning either with or without nasal passage occlusion (achieved with a swimmer's nose clip), followed by removal or application of the nose clip, respectively. After standardized induction of general anesthesia and muscle paralysis, a tight-fitting face mask was applied to each patient, and tidal volume was measured by the anesthesia machine during pressure-controlled ventilation (10, 15, 20 cm HO; 8 breaths·min; inspiratory:expiratory ratio 1:2).
The median [interquartile range] tidal volume was lower with vs without nasal passage occlusion at 10 cm HO inspiratory pressure (100 [55-134] mL vs 300 [230-328] mL, respectively; median difference (MD), 200 mL; 95% confidence interval (CI), 157 to 229; P < 0.001), 15 cm HO inspiratory pressure (190 [120-230] mL vs 520 [420-593] mL, respectively; MD, 340 mL; 95% CI, 257 to 395; P < 0.001), and 20 cm HO inspiratory pressure (270 [215-390] mL vs 790 [713-823] mL, respectively; MD, 520 mL; 95% CI, 390 to 582; P < 0.001).
Nasal passage obstruction considerably reduces tidal volume achieved during face mask ventilation. In some patients, it may be advantageous to relieve nasal airway obstruction for effective face mask ventilation.
UMIN Clinical Trials Registry, number UMIN000022184. Registered 2 May 2016.
既往研究表明，鼻腔在手动面罩通气中起着重要作用，但尚未对此进行定量评估。我们进行了一项前瞻性随机交叉临床试验，比较了带和不带鼻腔气道阻塞时压力控制面罩潮气量的变化。
择期全身麻醉下接受手术的女性患者作为研究对象。患者被随机分配至面罩通气，首先进行有或无鼻腔通道阻塞（采用游泳者鼻夹）的通气，随后分别去除或应用鼻夹。在全身麻醉和肌肉松弛的标准化诱导后，将每个患者的紧密贴合面罩应用于每个患者，并在压力控制通气期间通过麻醉机测量潮气量（10、15、20 cm H2O；8 次呼吸·min；吸：呼比 1:2）。
在 10 cm H2O 吸气压力时，与无鼻腔通道阻塞相比，带鼻腔通道阻塞时的潮气量中位数[四分位距]更低（100[55-134]mL 比 300[230-328]mL，中位数差（MD），200 mL；95%置信区间（CI），157 至 229；P<0.001），在 15 cm H2O 吸气压力时（190[120-230]mL 比 520[420-593]mL，MD，340 mL；95%CI，257 至 395；P<0.001），在 20 cm H2O 吸气压力时（270[215-390]mL 比 790[713-823]mL，MD，520 mL；95%CI，390 至 582；P<0.001）。
鼻腔通道阻塞可显著降低面罩通气时达到的潮气量。在某些患者中，为了有效进行面罩通气而缓解鼻腔气道阻塞可能是有利的。
UMIN 临床试验注册，注册号 UMIN000022184。2016 年 5 月 2 日注册。
