BVM Ventilation of the Edentulous Patient

BVM should be replaced with LMA ventilation. Aside from that, if this technique is half as effective as they suggest, we need to know about it because we bag a lot of edentulous patients.

Background: In edentulous patients, it may be difficult to perform face mask ventilation because of inadequate seal with air leaks. Our aim was to ascertain whether the "lower lip" face mask placement, as a new face mask ventilation method, is more effective at reducing air leaks than the standard face mask placement.

Methods: Forty-nine edentulous patients with inadequate seal and air leak during two-hand positive-pressure ventilation using the ventilator circle system were prospectively evaluated. In the presence of air leaks, defined as a difference of at least 33% between inspired and expired tidal volumes, the mask was placed in a lower lip position by repositioning the caudal end of the mask above the lower lip while maintaining the head in extension. The results are expressed as mean ± SD or median (25th-75th percentiles).

Results: Patient characteristics included age (71 ± 11 yr) and body mass index (24 ± 4 kg/m2). By using the standard method, the median inspired and expired tidal volumes were 450 ml (400 -500 ml) and 0 ml (0 -50 ml), respectively, and the median air leak was 400 ml (365-485 ml). After placing the mask in the lower lip position, the median expired tidal volume increased to 400 ml (380 – 490), and the median air leak decreased to 10 ml (0-20 ml) (P ± 0.001 vs. stan- dard method). The lower lip face mask placement with two hands reduced the air leak by 95% (80-100%).

Conclusions: In edentulous patients with inadequate face mask ventilation, the lower lip face mask placement with two hands markedly reduced the air leak and improved ventilation.

Racine et al. Face Mask Ventilation in Edentulous Patients. Anesthesiology 2010; 112:1190-3.