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Effect of paratracheal pressure on the effectiveness of mask ventilation in obese anesthetized patients: a randomized, cross-over study

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Abstract

Paratracheal pressure has been recently suggested to compress and occlude the upper esophagus at the lower left paratracheal region to prevent gastric regurgitation alternative to cricoid pressure. It also prevents gastric insufflation. The aim of this randomized cross-over study was to investigate the effectiveness of paratracheal pressure on mask ventilation in obese anesthetized paralyzed patients. After the induction of anesthesia, two-handed mask ventilation was initiated in a volume-controlled mode with a tidal volume of 8 mL kg‒1 based on ideal body weight (IBW), a respiratory rate of 12 breaths min− 1, and positive end-expiratory pressure of 10 cmH2O. Expiratory tidal volume and peak inspiratory pressure were recorded alternately with or without the application of 30 Newtons (approximately 3.06 kg) paratracheal pressure during a total of 16 successive breaths over 80 s. Association of patient characteristics with the effectiveness of paratracheal pressure on mask ventilation, defined as the difference in expiratory tidal volume between the presence or absence of paratracheal pressure were evaluated. In 48 obese anesthetized paralyzed patients, expiratory tidal volume was significantly higher with the application of paratracheal pressure than without paratracheal pressure [496.8 (74.1) mL kg− 1 of IBW vs. 403.8 (58.4) mL kg− 1 of IBW, respectively; P < 0.001]. Peak inspiratory pressure was also significantly higher with the application of paratracheal pressure compared to that with no paratracheal pressure [21.4 (1.2) cmH2O vs. 18.9 (1.6) cmH2O, respectively; P < 0.001]. No significant association was observed between patient characteristics and the effectiveness of paratracheal pressure on mask ventilation. Hypoxemia did not occur in any of the patients during mask ventilation with or without paratracheal pressure. The application of paratracheal pressure significantly increased both the expiratory tidal volume and peak inspiratory pressure during face-mask ventilation with a volume-controlled mode in obese anesthetized paralyzed patients. Gastric insufflation was not evaluated in this study during mask ventilation with or without paratracheal pressure.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Sheikh Khalifa Specialty Hospital, RAK, Ras al Khaimah, United Arab Emirates

    Taikyung Seol

  2. Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramaero 5-gil, Dongjakgu, Seoul, 07061, Republic of Korea

    Hyerim Kim, Jee-Eun Chang & Jin-Young Hwang

  3. Department of Anesthesiology & Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea

    Hyerim Kim, Jee-Eun Chang & Jin-Young Hwang

  4. Department of Anesthesiology & Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea

    Yeonsoo Kang

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  1. Taikyung Seol
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  3. Jee-Eun Chang
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  4. Yeonsoo Kang
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  5. Jin-Young Hwang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Taikyung Seol, Hyerim Kim, Jee-Eun Chang, Yeonsoo Kang, and Jin-Young Hwang. The first draft of the manuscript was written by Taikyung Seol, and Jin-Young Hwang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jin-Young Hwang.

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Seol, T., Kim, H., Chang, JE. et al. Effect of paratracheal pressure on the effectiveness of mask ventilation in obese anesthetized patients: a randomized, cross-over study. J Clin Monit Comput 38, 31–36 (2024). https://doi.org/10.1007/s10877-023-01048-8

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  • DOI: https://doi.org/10.1007/s10877-023-01048-8

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