Verification of Ventilation before Neuromuscular Blocker Administration during Anesthetic Induction and Endotracheal Tube Insertion in the Non-Rapid Sequence Induction Setting
Anatomically, the upper airway consists of the cartilaginous and bony structures of the nose and mouth, followed by the soft tissue of the oropharynx and laryngopharynx, and ending in the rigid trachea.1 The soft tissue of the pharynx is prone to collapse in the unconscious, or anesthetized, patient and may be further compromised by obesity, a large tongue, airway edema, large neck circumference, external compression, and many other factors.1,4 In response to this collapse, anesthesia professionals who plan to place an endotracheal tube have historically been instructed to refrain from administering muscle relaxation until adequate mask ventilation in the anesthetized patient was confirmed in order to both avoid a critical hypoxemic event, and to ensure an attempt at an escape wake up. However, there is little published evidence to support this practice, and the administration of muscle relaxation before ensuring adequate BVM ventilation remains controversial.1-8
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