TITLE:
Expiratory Upper Airway Obstruction Caused by the Soft Palate during Bag-Mask Ventilation
AUTHORS:
Charles W. Buffington, Cynthia M. Q. Wells, Ryan J. Soose
KEYWORDS:
Expiration; Soft Palate; Mask Ventilation
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.2 No.2,
April
19,
2012
ABSTRACT: Introduction: Expiratory upper airway obstruction during bag-mask ventilation is not well characterized. Methods: An audit was done to assess expiratory obstruction in 90 adult surgical patients undergoing bag-mask ventilation during the induction of general anaesthesia. Results: Clinicians experienced difficulty delivering gas to the lungs when the head was neutral in 52 of 90 patients (58%; inspiratory obstruction) but this problem was corrected by head tilt and chin lift in all but 2 patients. Clinicians experienced difficulty recovering gas from the lungs when the mouth was held closed under the mask in 30 of the remaining 88 patients (34%; expiratory obstruction). This problem persisted despite head tilt and chin lift in all but one patient but was uniformly corrected by opening the mouth. Inspection of the soft palate revealed that it was lying on the posterior pharyngeal wall in 27 of 30 patients with expiratory obstruction and that the retropalatal space was patent in 55 of 58 patients without expiratory obstruction (χ2, P