• Pankaj Kundra, Shirley Stephen, and Stalin Vinayagam.
• Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research Centre, Pondicherry, India.
• Indian J Anaesth. 2013 Mar 1; 57 (2): 175-9.

BackgroundIneffective face mask seal is the most common cause for suboptimal pre-oxygenation. Room air entrainment can be more with vital capacity (VC) breaths when the mask is not a tight fit.AimsThis study was designed to compare 5 min tidal volume (TV) breathing and eight VC breaths in patients with ineffective face mask seal.MethodsTwenty eight ASA I adults with ineffective face mask seal were randomized to breathe 100% oxygen at normal TV for 5 min (Group TV) and eight VC breaths (Group VC) in a cross over manner through circle system at 10 L/min. End tidal oxygen concentration (EtO2) and arterial blood gas analysis was performed to evaluate oxygenation with each technique.Statistical And AnalysisData were analysed using SPSS statistical software, version 16. Friedman's two-way analysis of variance by ranks was used for non-parametric data.ResultsSignificant increase in EtO2 (median 90) and PaO2 (228.85) was seen in group TV when compared to group VC (EtO2 median 85, PaO2 147.65), P<0.05. Mean total ventilation volume in 1 min in group VC was 9.4±3.3 L/min and more than fresh gas flow (10 L/min) in seven patients. In group TV, the fresh gas flow (50 L/5 min) was sufficient at normal TV (mean total ventilation in 5 min 36.7±6.3 L/min).ConclusionsTV breathing for 5 min provides better pre-oxygenation in patients with ineffective mask seal with fresh gas flow of 10 L/min delivered through a circle system.

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