چاپ صفحه |  صفحه نخست سامانه |  چکیده مقاله |  نویسندگان |  دانلود مقاله | دانشگاه علوم پزشکی تبریز |
| Efficient airway management is considered as an inevitablly vital skill required for emergency physicians [1]. Bag-mask-ventilation (BMV), the first step in airway management, is an essential rescue maneuver in situations where any attempt at establishing secure airway through intubation or supraglottic airway devices placement fails [2]. In spite of appearing a rather simple technique, performing appropriate BMV could accompany numerous difficulties. BMV should be performed by an experienced person so that the mask is placed firmly and appropriately and the required positive pressure is applied sufficiently. It should be emphasized that lack of expertise is considered a partial contraindication of performing BMV [3]. In the present article, we are to firstly describe Difficult Bag-Mask Ventilation (DMV), evaluate its associated risk factors and finally introduce the most recent approaches towards overcoming it. In an original report of the American Society of Anesthesiologists (ASA), Task Force on Management of the Difficult Airway, in 1993, the following definition of DMV was introduced: “DMV is a situation that develops when it is not possible for the unassisted anesthesiologist to maintain the oxygen saturation 90% using 100% oxygen and positive pressure ventilation, or to prevent or reverse signs of inadequate ventilation” [4]. 1. American Society of Anesthesiologists (ASA) consequently reported that DMV occurs in the situations in which the anesthesiologist is unable to establish ventilation using bagmask due to one or more of the following reasons [5]:inadequate mask seal 2. excessive gas leak 3. excessive resistance to the ingress or egress of gas Or whenever the following signs and symptoms of inadequate ventilation are present: 1. Absent or inadequate chest movement 2. Absent or inadequate breath sounds 3. Auscultatory signs of severe obstruction 4. Cyanosis 5. Gastric air entry or dilatation 6. Decreasing or inadequate oxygen saturation (SpO2) 7. Absent or inadequate exhaled carbon dioxide (ETCO2) 8. Absent or inadequate spirometric measures of exhaled gas flow 9. Hemodynamic changes associated with hypoxemia or hypercarbia (e.g., hypertension, tachycardia, and dysrhythmia). Additionally, in a valuable study carried out by Khaterpal et al., numerous significant risk factors for DMV have been introduced including: Age≥55yr, Male gender, Body Mass Index≥31 kg/m2, Junior anesthesia provider, Sleep apnea, Snoring, Presence of beard, Edentulousness, Thick neck, Neck radiation changes, Limited thyromental distance and Mallampati III or IV [6]. It should however be remembered that appropriate coverage of mouth and nose by mask is an essential basis of BMV as there are three major concerns regarding providing adequate ventilation using bagmask including inadequate tidal volume, inappropriate oxygenation and gastric insufflation. Therefore providing complete coverage of mouth and nose is inevitable for eliminating the first two concerns [7]. Herein we would discuss the most recent approaches towards DMV in general and specific (described by Kheterpal) conditions |
| نویسنده | نفر چندم مقاله |
|---|---|
| حسن سلیمانپور | اول |
| صمد اسلام جمال گلزاری | چهارم |
| نام فایل | تاریخ درج فایل | اندازه فایل | دانلود |
|---|---|---|---|
| E-DBMV.pdf | 1398/09/04 | 970262 | دانلود |
