Neuromuscular blockade affects facemask ventilation
In a “cannot intubate” scenario, facemask ventilation of the lungs is a potentially vital rescue intervention. In the present study, German researchers from the University Hospital of Cologne and the District Hospital Dormagen assessed the effect of neuromuscular blockade on expiratory tidal volumes in patients with expected difficulty in mask ventilation. Their conclusion: The administration of rocuronium is able to improve facemask ventilation in cases with a potentially clinically relevant increase in tidal volume; the early use of a neuromuscular blocking agent may be considered as a therapeutic option in cases of difficult mask ventilation.
The lungs of 113 patients with at least three predictors of difficulty in mask ventilation were ventilated with a facemask (two hands), and the mechanical ventilation was set in a pressure-controlled mode. The authors recorded tidal volumes before and after the establishment of complete neuromuscular block with rocuronium 0.6 mg/kg.
The median tidal volume increased from initially 350 ml to 517ml 30 seconds after rocuronium administration, an increase of 48 % (p < 0.001). After the onset of the complete neuromuscular block, the median tidal volume was 600 ml: an increase of 71 % from baseline (p < 0.001), and an increase of 16 % from values obtained 30 seconds after rocuronium administration (p = 0.003). There was no decrease in the tidal volume during the measurements.
The authors conclude that the administration of rocuronium may improve facemask ventilation in patients with a potentially clinically relevant increase in tidal volume.