Comparative Analysis of Facemask Ventilation Effectiveness Pre and Post Neuromuscular Blocking Drug Administration: A Prospective Observational Study

The most fundamental and important skill in airway management is facemask ventilation, which is the primary line of treatment in patients who are apnoeic. It is an essential element of airway management skills crucial for both general anaesthesia and rescue oxygenation. During general anaesthesia, it is vital for ensuring adequate oxygenation and ventilation of the patient after the administration of anaesthetic / muscle relaxant agents. This technique involves placing a mask over the patient’s nose and mouth and applying positive pressure to facilitate the flow of oxygen or anaesthetic gases into the lungs. In emergency situations, facemask ventilation becomes an indispensable tool for providing immediate oxygenation to the patients who are unable to breathe independently. Mastery of this skill is essential for preventing complications such as hypoxia and ensuring effective airway management in a variety of clinical scenarios. The routine use of neuromuscular blocking drugs (NMBDs) before testing mask ventilation is a subject of debate. While NMBDs generally assist with intubation and may improve facemask ventilation, they can also obstruct ventilation by causing upper airway collapse. Advocates for "testing" the ability to ventilate before administering NMBDs argue that the risk of complete airway obstruction due to NMBD induced collapse could lead to a “cannot intubate, cannot ventilate” scenario if intubation attempts fail. On the other hand, some suggest that residual muscle tone after anaesthesia induction might create resistance during mask ventilation, which could be misinterpreted as difficult mask ventilation. DMV arises as a result of several technique-related and / or airway-related issues. . There is some evidence for administering an NMBD immediately after induction to facilitate ventilation, enabling early identification of patients at risk of difficult ventilation, facilitating prompt airway management, potentially reducing the risks associated with hypoxia. Therefore, the current study is envisaged to assess how neuromuscular blocking medication affects facemask ventilation in individuals undergoing general anaesthesia.