facemask during general anesthesia

[Nick8]

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How long can I mantain general anesthesia with sevoflurane by using facemask positive pressure ventilation. Is it possible to do it more than 30 minutes?or I have to use LMA ?
Thank you very much in advance.

 

[DannyB]

How long can I mantain general anesthesia with sevoflurane by using facemask positive pressure ventilation. Is it possible to do it more than 30 minutes?or I have to use LMA ?
Thank you very much in advance.

Until your hand gets tired

 

[periopdoc]

Only you can answer that question.

It depends on the patient and on your skill level.

Are you a internal medicine physician doing a critical care residency or have you completed some anesthesia training as well?

- pod

 

[RxBoy]

How long can I mantain general anesthesia with sevoflurane by using facemask positive pressure ventilation. Is it possible to do it more than 30 minutes?or I have to use LMA ?
Thank you very much in advance.

I don't think there are any guidelines that I am aware of but this is the way they used to do it back in the day. However I think its dangerous, especially for long procedures. Every time you give positive pressure, you risk opening the LES and insufflating the belly with air. Over time this can potentially build up and cause regurg->aspiration. I've done it once for a D&C and it is a pain in the arse. Unless you can position the pt perfectly with the mask straps, your gonna have to sacrifice a hand thrusting the jaw and sealing the mask. LMA's are much easier to use, so why not just use an LMA? True, LMA can be malpositioned in the esophagus and cause regurg but I think the incidence is much lower (although I have no scientific proof).

A much safer way is to not provide PPV. Just have patient breath spontaneous with maybe a little support with a CPAP of 5ish. Thats how we did all our ear tube cases in peds, mainly because the rapid turnover with no IV access. But again if you wanted to use for longer term, I would still LMA especially if I had access to an IV.

 

[jwk]

Back in the old days (>30 years ago) we did tons of 3hr+ mask cases during training. There was no such thing as an LMA - it was either ETT or mask. And of course back in the 50's and earlier, ETT's were a rarity. There were lots of ways to deal with long mask cases, including using oral or nasal airways and a mask strap. The masks were all reusable and the better ones far easier to use than the disposable ones we use now.

As soon as I got into private practice, I was informed by the docs in my new practice that the first indication for intubation was convenience of the anesthetist. 🙂

I still do short cases with a mask - D&C's, simple cystos, ear tubes, etc. Anything longer than 10-15 minutes is getting an LMA.

 

[Mman]

I don't think there are any guidelines that I am aware of but this is the way they used to do it back in the day. However I think its dangerous, especially for long procedures. Every time you give positive pressure, you risk opening the LES and insufflating the belly with air. Over time this can potentially build up and cause regurg->aspiration. I've done it once for a D&C and it is a pain in the arse. Unless you can position the pt perfectly with the mask straps, your gonna have to sacrifice a hand thrusting the jaw and sealing the mask. LMA's are much easier to use, so why not just use an LMA? True, LMA can be malpositioned in the esophagus and cause regurg but I think the incidence is much lower (although I have no scientific proof).

A much safer way is to not provide PPV. Just have patient breath spontaneous with maybe a little support with a CPAP of 5ish. Thats how we did all our ear tube cases in peds, mainly because the rapid turnover with no IV access. But again if you wanted to use for longer term, I would still LMA especially if I had access to an IV.

I'm gonna guess an LMA is higher risk for aspiration than a mask case because an LMA is stimulating in the back of the pharynx and if the patient gets light it could lead to gagging and vomiting. A mask doesn't stimulate the patient's airway at all. And as mentioned above, you can just let them breathe spontaneously through it without necessarily needing to give big positive pressure breaths every time.

 

[Arch Guillotti]

I've done it once for a D&C and it is a pain in the arse. Unless you can position the pt perfectly with the mask straps, your gonna have to sacrifice a hand thrusting the jaw and sealing the mask. LMA's are much easier to use, so why not just use an LMA? True, LMA can be malpositioned in the esophagus and cause regurg but I think the incidence is much lower (although I have no scientific proof).

Masking a patient for a D & C should be a piece of cake/

LMA's are not risk-free, although risk is probably pretty minimal for a short case.

 

[Dejavu]

After 36 yrs of doing anesthesia, both as a CRNA and MD, I still love mask cases.

You are never as connected to your pt as when you have one hand on the jaw and one on the bag, feeling to determine the size and pattern of spontaneous respiration. If the pt got light they breathed faster, give some narcs and you could tell when they started working because the breaths got deeper and fewer.

A connection not seen with ventilators and such.

However, with computers that need data entry for charting nowdays, one can hardly devote both hands to the airway anymore like you could sitting with a paper chart.

I mourn the loss of mask ventilation expertise in the profession now that all the masking our new trainees get is waiting for the succs to hit.

 

[jwk]

I mourn the loss of mask ventilation expertise in the profession now that all the masking our new trainees get is waiting for the succs to hit.

Absolutely - for those of you complaining about how "difficult" a mask airway is, you simply need more practice - a LOT more.

 

[Mman]

Absolutely - for those of you complaining about how "difficult" a mask airway is, you simply need more practice - a LOT more.

To be fair that depends on the patient population. Our median BMI for an adult surgical patient is probably around 35 and seeing 40-50+ is routine. Mask cases are easy on most normal healthy individuals. But in many parts of the country, that type of patient is becoming rarer every year.

 

[urge]

After 2 hrs my hands start cramping.....

 

[Oggg]

At my place we have few surgeries that can be done with less than 5 minutes of face mask. After 5 minutes, my attention span is shot. It's too hard to surf the web or read the paper while face masking.

 

[Nick8]

Thank you very much for your useful and interesting answers!

 

[HollywdAnesth]

With a head strap, you could sometimes do it until your Sevo ran out.

 

[hoyden]

With a head strap, you could sometimes do it until your Sevo ran out.

plus the trumpets and lidocaine gel 🙂