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Facemask ventilation and vocal cord angle following neuromuscular blockade: a prospective observational study#
Anaesthesia ( IF 10.7 ) Pub Date : 2022-06-21 , DOI: 10.1111/anae.15786
M K Lee 1 , K N Kim 1 , M A Jeong 1 , S Y Kim 1 , M S Oh 2 , B S Kwon 1
Affiliation  

Numerous studies support the idea that neuromuscular blockade facilitates facemask ventilation after induction of anaesthesia. Although improved airway patency or pulmonary compliance and a resolution of laryngospasm have been suggested as possible causes, the exact mechanism remains unclear. We aimed to assess whether neuromuscular blockade improves facemask ventilation and to clarify whether this phenomenon is associated with the vocal cord angle. This prospective observational study included patients aged between 20 and 65 years scheduled for elective surgery under general anaesthesia. After induction of anaesthesia, patients' lungs were ventilated with pressure-controlled ventilation using a facemask. During facemask ventilation, a flexible bronchoscope was inserted through a self-sealing diaphragm at the elbow connector attached to the facemask and breathing circuit and positioned to allow a continuous view of the vocal cords. The mean tidal volume and vocal cord angle were measured before and after administration of neuromuscular blocking drugs. Of 108 patients, 100 completed the study. Mean (SD) tidal volume ((11.0 (3.9) ml.kg-1 vs. 13.6 (2.6) ml.kg-1; p < 0.001) and mean (SD) vocal cord angle (17° (10°) vs. 26° (5°); p < 0.001) increased significantly after neuromuscular blockade. The proportional increase in mean tidal volume after neuromuscular blockade was positively correlated with vocal cord angle (Spearman's ρ = 0.803; p < 0.001). In conclusion, neuromuscular blockade facilitated facemask ventilation, and the improvement was correlated with further opening of the vocal cords.

中文翻译:

神经肌肉阻滞后的面罩通气和声带角度:一项前瞻性观察研究#

大量研究支持神经肌肉阻滞促进麻醉诱导后面罩通气的观点。尽管已经提出改善气道通畅或肺顺应性以及喉痉挛的消退是可能的原因,但确切的机制仍不清楚。我们旨在评估神经肌肉阻滞是否能改善面罩通气,并阐明这种现象是否与声带角度有关。这项前瞻性观察性研究包括年龄在 20 至 65 岁之间的患者,这些患者计划在全身麻醉下进行择期手术。麻醉诱导后,使用面罩对患者的肺部进行压力控制通气。在面罩通气期间,通过连接到面罩和呼吸回路的肘部连接器处的自密封隔膜插入柔性支气管镜,并定位以允许连续观察声带。测量神经肌肉阻滞药物给药前后的平均潮气量和声带角。在 108 名患者中,100 名完成了研究。平均 (SD) 潮气量 ((11.0 (3.9) ml.kg-1对 13.6 (2.6) ml.kg -1;p < 0.001) 和平均 (SD) 声带角度 (17° (10°) vs. 26° (5°); p < 0.001) 在神经肌肉阻滞后显着增加。神经肌肉阻滞后平均潮气量的比例增加与声带角度呈正相关(Spearman ρ = 0.803;p < 0.001)。总之,神经肌肉阻滞促进了面罩通气,并且改善与声带的进一步开放相关。
更新日期:2022-06-21
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