Efficacy of novel EP technique of mask ventilation versus standard CE technique in obese patients for general anaesthesia

Mask ventilation is the primary technique of ventilation before intubation or insertion of any airway devices during general anaesthesia.It is also a rescue technique for ventilation during unsuccessful attempts at intubation and difficult airway situations. There can be several factors contributing to inadequate mask ventilation that can be classified as patient related (such as beard, edentulous, thick neck),equipment related (inappropriate size mask ,non cushioned rim of the masks) or operator related factors (inexperience ,improper technique).

Airway management is more challenging in obese patients. They have impaired respiratory mechanics, decreased FRC and vital capacity ,increased airway resistance and reduced oxygen reserve. Maintaining airway  patency may be difficult in obese patients due to high collapsibility of upper airway structures and technical difficulty in applying the mask. Sustained effective mask ventilation becomes difficult in obese patient due to strain because of the heavy jaw and large neck circumference causing fatigue to the operator.

In order to tackle these difficulties we are studying an alternative novel technique which is a variant of VE technique named as EP technique. This technique provides a better seal and is an easy and strain free method than the standard CE technique that we use in mask ventilation .The CE technique applies the mask by forming a C shape with each thumb and index finger over each side of the mask while the third ,fourth and fifth fingers of both hands lift the mandible towards the mask in a three fingered E shape .In contrast, the EP technique uses each thumb over the mask which pushes the mask down to provide a better seal, while the second to fourth digits are along the mandible like an E that pull it upwards and the little finger behind the pinna for a better grip ,support and stability .This will not only improve the quality of ventilation ,ie, oxygenation and outcomes but also makes the operator fatigue free