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Effect of an endoscopic bite block on one-handed mask ventilation

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Abstract

Purpose

An endoscopic bite block is a device to ensure that the patient’s mouth remains wide open during endoscopic procedures. Wide opening of the mouth may facilitate the efficiency of one-handed mask ventilation. We evaluated the effect of an endoscopic bite block on mask ventilation among three ventilation techniques: one-handed ventilation, one-handed ventilation with an endoscopic bite block, and two-handed ventilation.

Methods

Fifty-nine anesthetized and paralyzed patients were included. After induction of anesthesia, one-handed ventilation, one-handed ventilation with an endoscopic bite block and two-handed ventilation were performed in a cross-over, randomized order. The primary outcome was the expiratory tidal volume (mL/kg of predicted body weight). Secondary outcomes included minute ventilation (L/min) and the incidence of inadequate mask ventilation or dead space ventilation.

Results

The expiratory tidal volume of one-handed ventilation with an endoscopic bite block was significantly improved when compared with that of one-handed ventilation (8.2 [6.8–10.2] mL/kg vs. 7.1 [4.5–9.0] mL/kg, respectively, difference = 1.1 mL/kg; 95% CI 0.8–2.4; P < 0.001), and was comparable to that of two-handed ventilation (8.9 [6.3–11.5] mL/kg; difference = 0.7 mL/kg; 95% CI − 0.7 to 1.5; P = 0.432). Minute ventilation was also significantly improved in one-handed ventilation with an endoscopic bite block compared with that in one-handed ventilation (7.4 [6.3–8.6] L/min vs. 6.7 [4.2–7.9] L/min, respectively, difference = 0.7 L/min; 95% CI 0.6–2.0; P < 0.001), and was comparable to that of two-handed ventilation (7.7 [6.5–9.5] L/min; difference = 0.3 L/min; 95% CI − 0.5 to 1.4; P = 0.390). The incidence of inadequate ventilation or dead space ventilation was not different among the ventilation techniques (P = 0.080).

Conclusion

The use of an endoscopic bite block improved one-handed mask ventilation, showing comparable efficacy with two-handed mask ventilation.

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Acknowledgements

The authors would like to thank Sohee Oh, PhD of the Department of Biostatistics in Seoul Metropolitan Government Seoul National University Boramae Medical Center for statistical advice.

Funding

This study was not funded.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea

    Hyerim Kim, Jee-Eun Chang, Jung-Man Lee, Dongwook Won, Hyo Jun Yang & Jin-Young Hwang

  2. Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea

    Jin-Young Hwang

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  1. Hyerim Kim
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  2. Jee-Eun Chang
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  3. Jung-Man Lee
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Correspondence to Jin-Young Hwang.

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Kim, H., Chang, JE., Lee, JM. et al. Effect of an endoscopic bite block on one-handed mask ventilation. J Anesth 34, 211–216 (2020). https://doi.org/10.1007/s00540-019-02732-3

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