Department of Anaesthesia and Intensive Care, Kreiskrankenhaus Dormagen, Germany.
Department of Anaesthesia and Intensive Care Medicine, University Hospital of Cologne, Germany.
Anaesthesia. 2017 Dec;72(12):1484-1490. doi: 10.1111/anae.14035. Epub 2017 Sep 14.
Facemask ventilation of the lungs can be an important rescue intervention in a 'cannot intubate' scenario. We assessed the effect of neuromuscular blockade on expiratory tidal volumes in patients with expected difficulty in mask ventilation. The lungs of patients with at least three predictors of difficulty in mask ventilation were ventilated using a facemask held with two hands, with mechanical ventilation set in a pressure-controlled mode. Tidal volumes were recorded before and after the establishment of complete neuromuscular block. In 113 patients, median (IQR [range]) tidal volume increased from 350 (260-492 [80-850]) ml initially, by 48% to 517 (373-667 [100-1250]) ml 30 s after rocuronium administration, (p < 0.001). After the onset of the complete neuromuscular block, a median tidal volume of 600 (433-750 [250-1303]) ml was observed, corresponding to an increase of 71% from baseline values (p < 0.001), and 16% from values obtained 30 s after rocuronium administration, respectively; p = 0.003). No decrease in the tidal volume during the measurements was observed. We conclude that the administration of rocuronium at a dose of 0.6 mg.kg was able to improve facemask ventilation in all cases with a potentially clinically relevant increase in tidal volume. The early use of a neuromuscular blocking agent can be considered as a therapeutic option in case of difficulty with mask ventilation.
面罩通气在“无法插管”的情况下可能是一种重要的抢救干预措施。我们评估了神经肌肉阻滞对预计面罩通气困难患者的潮气量的影响。使用双手固定面罩，以压力控制模式进行机械通气，对至少有三个面罩通气困难预测因素的患者的肺进行通气。在建立完全神经肌肉阻滞之前和之后记录潮气量。在 113 名患者中，中位（IQR [范围]）潮气量最初为 350（260-492 [80-850]）ml，通过罗库溴铵给药后 30 秒增加 48%至 517（373-667 [100-1250]）ml，（p < 0.001）。在完全神经肌肉阻滞发作后，观察到中位潮气量为 600（433-750 [250-1303]）ml，与基线值相比增加了 71%（p < 0.001），与罗库溴铵给药后 30 秒获得的值相比增加了 16%；p = 0.003）。在测量期间未观察到潮气量下降。我们得出结论，在所有情况下，给予 0.6 mg.kg 的罗库溴铵剂量能够改善面罩通气，并使潮气量有潜在临床相关的增加。在面罩通气困难的情况下，早期使用神经肌肉阻滞剂可被视为一种治疗选择。
