The Clinical Observation Of That The Application Of Mask Ventilation With Oropharyngeal Airway In The Obese Patient

Background：As people change of the life way and the improvement of living standards, theincidence of obesity shows a trend of increasing year by year, obesity has become oneimportant factors of that endanger human health. Obese patients because the physiologicaland anatomical structure change, which often brings great difficulty to clinical anesthesia,especially induction of general anesthesia, because maxillofacial and oropharyngeal fattytissue accumulation of obese patients, tongue to airway obstruction, leading to a mask cannot be effectively ventilated, this significant increase obesity patients perioperative risks andaccidents.Oropharyngeal airway is an endotracheal tube ventilation pipes commonly used inclinical anesthesia, as important auxiliary ventilation tool. It can effectively solve theglossoptosis caused by the mask ventilation, and open airway, and get effective ventilation,to a certain extent, and also can solve the problem of difficult airway ventilation. In recentyears, oropharyngeal airway and mask ventilation is a commonly used, emergency, rapidlycarried out ventilation method, during the induction of anesthesia, tracheal extubation andemergency dealing with a wide range of applications.The ventilation pressure of the obese patients is higher than the lower esophagealsphincter （normal pressure of approximately30cmH₂O） during mask ventilation, and it willcause the gas into the stomach, and bring out flatulence. According to the statistics ofnoninvasive ventilation, flatulence occurrence rate is21%⁴6%, obese patients significanthigher than normal weight, and obese patients appear even aspiration and acute respiratorydistress syndrome crisis situation. Therefore, the obese patient must adjust ventilationpressure, so as not to induce flatulence, reflux complications during mask ventilation.The mask ventilation induced obese patient flatulence, in order to reduce the occurrenceof this complication. The experimental observe the pharyngeal airway and ventilationentrance under the pressure of the tidal volume and gastric inlet relationship of the obesepatient mask ventilation, in order to obtain a reasonable respiratory parameters of the obesepatient during mask ventilation. These respiratory parameters helps guide clinical anesthesia,to provide scientific basis for the obese patient mask ventilation. Objective：Observed the relation of that different tidal volume generated airway pressure andgastric inlet incidence whether input oropharyngeal airway in obese patients during maskventilation.Methods：40cases obese patients which were come from the First Affiliated Hospital of JilinUniversity undergoing elective operation with the conditions that selected general anesthesiafrom June of2010to March of2011were divided into control group （group A） andexperimental group （group B） according the admission time and there were20cases pergroup. Inclusion criteria is that ASAI-II and BMI>30exclusion of airway obstruction andfacial deformity to mask sealed lax.Mask inhalation of pure oxygen3minutes beforeinduction and the induction was using fentanyl, propofol and muscle relaxant and maskventilation from spontaneous breathing disappears to tracheal intubation. we fixed the maskon the face With the headband and lift mandibular angle with two hands,allowing patients tohead back in order to facilitate the airway.The ventilator settings using capacity controlmode, respiratory frequency is12times per minute, breath ratio1:2, adjust the tidal volumefrom6ml.kg^-1 to7ml.kg^-1,8ml.kg^-1,9ml.kg^-1,10ml.kg^-1, A record of each peak airwaypressure, the actual tidal volume,Patients that no oropharyngeal airway who’s Ventilationpressure reached35cm for the first time or intragastric intake without improvement afteradjusted that be considered absolutely difficult in mask ventilation and choose otherventilation scheme.auscultation with a stethoscope under the xiphoid5cm to hear the soundof gas entering the the stomach was considered positive signs and recorded positive rateunder different input tidal volume and tidal volume is no longer increasing input.ifinadequate ventilation in patients who no oropharyngeal airway,should terminate theobservation, put in the oropharyngeal airway and increase the tidal volume.The wholeprocess monitoring of oxygen saturation of blood oxygen saturation, if the SpO₂lower than90%, patients cannot tolerate the termination of observation, increased tidal volume.Results1：airway pressure comparison of two groups of patientsgroup B airway pressure was lower than group A with the same tidal volume, two grouphad a significant difference（p>0.05）, all patients of group B with good ventilation,, airwaypressure increases gradually with input elevated tidal volumes, Airway pressure is22-26cmH₂O when tidal volume reached8ml.kg^-1. Results2：the comparison when gas into the stomachairway pressure increased of two groups along with the input increased tidalvolume,when the airway pressure rises to about28-30cmH2O, gas into the stomach,occurrence of flatulence, group B positive rate （1/20） was significantly lower than that ofgroup A （7/20） when the tidal volume reached8ml/kg; the actual tidal volume of group Bwas significantly elevated than that of group A when gas into the stomach.Conclusion：Obese patients is difficulty when mask ventilation, prone to gastric inlet,8ml/kg tidalvolume can achieve good ventilation effect and also can reduce stomach flatulence,placement of oropharyngeal airway can decrease the ventilation resistance and the incidenceof stomach flatulence rate, to achieve the ideal ventilation effect.