Comparison of Facemask Ventilation Quality Between the Three-Finger Grip and the Three-Finger Grip Plus the Newly-Devised Submental Maneuver in Infants: A Double-Blind, Randomized Controlled Trial

Background: Mask ventilation is one of the most important aspects of managing and maintaining a patient's airway. Performing good mask ventilation can avoid the need for intubation. Objectives: This study aimed to compare the ventilation quality of two different mask-holding techniques in infants: The three-finger grip and the three-finger grip plus the newly-devised submental maneuver. Methods: This double-blind, randomized controlled trial included 90 infants under 1 year of age undergoing elective surgery under general inhalation anesthesia in Tehran Children's Medical Center. Each patient was randomly allocated to one of the interventional groups, and general anesthesia was induced using one of the mask-holding techniques before intubation. Demographic data for each patient was collected. Expired tidal volume (VTE) was assessed quantitatively by the Drager machine and then classified into three groups of quality of breath flow as either good (5 - 7 mL/kg), fair (3 - 5 mL/kg), or bad (< 3 mL/kg). Results: In this study, VTE was shown to be statistically significantly better in the submental maneuver compared with the three-finger grip. Good, fair, and bad qualities were recorded for 30, 15, and 0 patients in the three-finger grip group and 39, 6, and 0 patients in the submental maneuver group, respectively (P = 0.025). Classifying patients into four groups of body mass index (BMI), 10 - 14, 15 - 19, 20 - 24, and 25 - 29, we compared VTE between the two techniques within each group. The results showed that in the BMI group of 20 - 24, the quality of breath flow was statistically significantly better in the submental maneuver (P = 0.047). Conclusions: Adding the submental maneuver to the three-finger grip seems to provide better expired tidal volume in infants. Also, it seems that in children with higher BMI and larger submental soft tissue, the submental maneuver provides better ventilation quality than the three-finger grip.