Shetti's maneuver

Sir,

Different techniques are used to hold mask during induction and maintenance of anesthesia. Single hand technique, double hand technique and bagging by second person or by ventilator, Esmarch-Heiberg maneuver, claw hand technique etc., depending upon situation.[1] Shetti's maneuver can be used during mask ventilation by two hand technique. This technique differs from conventional two hand technique in a way non-dominant hand of Anesthesiologist will take support from the ipsilateral side of the shoulder. The dorsal aspect of non-dominant hand from wrist till metacarpophalengeal joint rests on ipsilateral shoulder, while fingers of same hand giving jaw thrust at angle of mandible as shown in Figure 1. One can utilize middle/index/ring finger alone or combination of any. The dominant hand does chin lift and supports mask [Figure 2]. Most of the energy is spent during mask holding is while giving jaw thrust. When a dedicated hand takes care of jaw thrust, then mask holding will be easier. The advantages of this maneuver are it is easy and avoids. One of the cause for improper ventilation is improper mask holding. Achieving adequate tidal volumes with bag-mask ventilation requires a tight mask seal and appropriate compression of the bag. This technique not only allows proper mask holding, but also in certain scenarios where unexpected prolonged anesthesia is encountered. Many of the short surgeries are performed by general anesthesia with mask, wherein unexpected prolongation of procedure makes difficult to hold the mask leading to fatigability. Unavailabilityof supra-glottic airway device or Anesthesiologist who is untrained for insertion technique makes mask holding as common technique. Limitations of this maneuver are, Anesthesiologist who is having short hand may not get sufficient length and if the surgery is of ipsilateral shoulder then place for non-dominant hand may not be available. Though, it is a good maneuver according to our clinical experience, the usefulness has to be studied in a large numbers. We feel this is simple and an effective maneuver.

Figure 1.

Non-dominant hand on ipsilateral shoulder

Figure 2.

Position of dominant hand