Manual vs. Mechanical Mask Ventilation during Induction of General Anesthesia
—A Practice Changing Retrospective Study

Background: Effective ventilation during the induction of anesthesia is crucial for patient safety, yet the comparative effectiveness of mechanical versus manual ventilation techniques remains inadequately explored. This study evaluates whether mechanical mask ventilation yields lower peak inspiratory pressures (PIP) than traditional manual ventilation, and discusses the science of effective and safe methods of mask ventilation. Methods: A retrospective cohort analysis was conducted at a tertiary hospital in the United Arab Emirates, reviewing anesthetic charts from 104 patients who underwent general anesthesia with endotracheal intubation. After excluding 9 cases due to insufficient data, 95 patients were analyzed. Data on peak inspiratory pressures, ventilation techniques, and patient demographics were extracted and compared statistically. Additionally, a clinical survey was distributed to anesthesiologists to gather qualitative insights on their experiences and preferences regarding both ventilation methods. Results: The mechanical mask ventilation group (n = 8) exhibited a mean PIP of 16.75 cm H₂O, significantly lower than the 23.76 cm H₂O in the manual group (n = 87). Notably, only 25% of mechanical cases exceeded 20 cm H₂O compared to 79.3% in the manual group, underscoring the mechanical method’s superior control over airway pressures. Survey responses indicated that 66% of anesthesiologists preferred manual ventilation due to familiarity and perceived reliability, while 34% favored mechanical ventilation for its consistency and reduced physical effort. Conclusion: This study demonstrates that mechanical mask ventilation results in lower peak inspiratory pressures compared to manual techniques, potentially enhancing patient safety during anesthesia induction. Despite this, a significant preference for manual ventilation persists among anesthesiologists, highlighting the need for balanced training in both techniques. These findings contribute valuable insights for optimizing ventilation practices in clinical anesthesia.