Comparison of three methods in improving bag mask ventilation

Increasedlife expectancy in populations has brought
along specific new scenarios in the fields of medicine for the
elderly; prevalence of physical complications such as edentulism
and patients with dentures is growing. Management of anesthesia
and ventilation in this group of patients has turned into a great
challenge. Some researchers suggest dentures to be left in place
during bag‑mask ventilation; yet, no unanimous agreement exists
in this regard.
Methods: In a single blind randomized clinical trial, we
studied 300 patients with ASA class I, II (American Society of
Anesthesiologists), Mallampati class (I, II) and aged over 55 years
in three groups. After induction of anesthesia, in group G dentures
were removed and in each buccal space an eight‑layer 10 × 10 cm
gauze and an oral airway were placed. In group D, the dentures
and an oral airway were left in place. In group C (control), after
removing dentures just an appropriate oral airway was placed.
Then, each three group underwent bag‑mask ventilation. Success
of bag‑mask ventilation (BMV) was considered as increase in
end‑tidal carbon dioxide to more than 20 mmHg and back to
baseline with fresh gas flow of 3 L/min and adjustable pressure
limiting valve pressure of 20 cm H2O. Success rates were evaluated
between groups.
Results: Effective BMV was possible in 91 (91%), 64 (64%)
and 41 (41%) patients in groups G, D and C respectively. The
differences were statistically significant. Successful BMV rate
was significantly higher in female patients in group G compared
to group C; 43/44 versus 25/46 individuals, P = 0.0001, odds
ratio = 0.03, 95% confidence interval (0.00, 0.22).
Conclusions: Leaving dentures in place in edentulous patients
after inducing anesthesia improves bag‑mask ventilation. However,
placing folded compressed gauze in buccal space leads to more
significant improvement in BMV compared to leaving dentures in
place.