Investigating the incidence and causes of difficult mask ventilation in geriatric patients

Objective: The geriatric population constitutes the fastest growing part of the population in many developed regions worldwide. Increase in the average life span has led to a growth of geriatric population as well as the anesthesia applications to become more specific for the geriatric patients who are potantially subject to surgical procedures. Mask ventilation is the basic element of the airway management. Furthermore, successful mask ventilation is a life-saving basic airway management technique that enables oxygenation and ventilation in airways that endotracheal intubation or other techniques (tracheostomy, cricothyrotomy) have already failed. The aim ofthis study was to determine the incidence and the causes of difficult mask ventilation in geriatric patients, as well as to identify the geriatric patient population that may be encountered in daily practice in the operating room. Materials and methods: This study was conducted with a total of 254 ASA1-4 patients aged 65 and over, who will be electively operated under general anesthesia. We evaluated the participating patients the day before surgery and completed the DMV 1 (difficult mask ventilation) form, that we modified from Langeronet al.?s original form of difficult mask ventilation. At the day of surgery, following mask ventilation, the DMV 2 form, which included the scale of difficult mask ventilation of Han et al, was completed for the same patients. In order to detemine the size of the geriatric patient population operated in daily operating practice, as well as the causes and incidence of difficult mask ventilation in geriatric patients, current forms were evaluated. Findings were entered into the database created in the SPSS 15 program. The current variables were compared with Kruskal-Wallis, ManWhitney U and Chi-square test. For all tests, type 1 error was determined as ?: 0.05 and tested in a two-way analysis of variance, and '' p'' value <0.05 was considered statistically significant for the differences between the groups. Results: We conducted our study between November 2012 and May 2013 and 2500 geriatric patients have been operated in the central operating room, ambulatory surgery hospital and non-operating room anesthesia centers of Dokuz Eylul University, Faculty of Medicine, University Hospital in this 8-month period. Out of these, 254 patients who were operated under general anesthesia in the central operating room center were included in the study. Of the enrolled patients, 32.7% were grade 1 mask ventilation, 54.7% grade 2 mask ventilation, 12.6% grade 3 mask ventilation. There was no grade 4 mask ventilation. Mallampati score, mouth opening, thyromental distance, sternomental distance, mandibular protrusion test, snoring history, edentation, body mass index, neck movements, opiate agent and muscle relaxant agent use during anesthetic induction were not correlated with difficult mask ventilation. According to the data obtained from the hospital system analysis unit, one or more surgical procedure codes have been entered according to the coverage of the operation performed for each patient and a total of 27.381 surgical procedures have been coded within one-year period between January 2012 and January 2013. Of these surgical procedure codes, 7948 implicated patients aged 65 years and over. According to these data, the percentage of geriatric patient population undergoing surgery was found to be 29% of the total population having undergone surgical operations. Conclusion: In this study, the incidence of difficult mask ventilation was found to be 12.6% in geriatric patient population. Male gender, thick neck circumference, having beard in male patients and experience level of the anesthesiologist were determined as independent risk factors for difficult mask ventilation. Key words: geriatric patient, difficult mask ventilation