Superiority of the Bag-Valve-Guedel Adaptor Over the Standard Face Mask for Preintubation Ventilation of Bearded Patients by Trainees With Limited Experience: Prospective Controlled Cross-Over Clinical Trial.

Abstract

Objectives: Ventilation of bearded patients using the standard face mask (FM) is often difficult, particularly in field settings and mass casualty events. The current study compares the effectiveness of a novel Bag-Valve-Guedel Adaptor (BVGA) with the standard FM when applied to anesthetized patients by anesthesiology trainees with limited experience.

Methods: Male patients scheduled for elective surgery (American Society of Anesthesiology physical score 1-2) were recruited for this prospective, randomized, cross-over trial. Beard length was categorized as <0.5 cm (none/stubble), 0.5 to 1 cm, 1 to 5 cm, or ≥5 cm. Anesthetized patients were ventilated by anesthesiology trainees using the BVGA and an FM. The main outcome included end-tidal CO₂, expiratory tidal volume (tidal volume of predicted body weight), and user evaluation (comfort, physical demand, and tiredness). The role of the level of expertise was evaluated by comparing data from the present study with those of a previous study performed by attending anesthesiologists.

Results: Forty men (mean ± SD, age, 37 ± 17 years; body mass index, 25 ± 3 kg/m²), of whom 30 had beards, were enrolled. For the BVGA, ventilation parameters were found to be superior to the FM (BVGA vs FM: end-tidal CO₂ [mm Hg], 34.3 ± 4.9 vs 26.6 ± 5.8, P < .001; expiratory tidal volume [mL/kg predicted body weight], 7.9 ± 2.5 vs 6.3 ± 2.8, P = .003). The BVGA was graded as more comfortable and less physically demanding by 96% to 100% of trainees. The level of expertise of the anesthesiologist (trainee vs attending [additional n = 61 patients]) and the presence of a beard were found to be significant factors for ventilation with the FM but not with the BVGA.

Conclusion: The BVGA provides more effective and convenient ventilation than the FM for ventilation even when applied by anesthesia trainees. Its use can be of particular value in bearded subjects or in a setting where the use of supraglottic airway devices is limited.