Comparison of Two-handed Mask Ventilation using C-E versus V-E Techniques for Induction of General Anaesthesia: A Randomised Clinical Trial

Introduction: Mask ventilation is a fundamental skill in airway management, requiring optimal hand positioning for effective ventilation. Two-handed techniques are preferred for challenging mask ventilation scenarios. Aim: To compare the effectiveness of the C-E versus the V-E techniques of two-handed mask ventilation during the induction of general anaesthesia. Materials and Methods: This randomised clinical trial was conducted in the Department of Anaesthesiology at Dhiraj General Hospital, Vadodara, Gujarat, India from August 2024 to July 2025. Seventy adult patients (American Society of Anaesthesiologists (ASA) I-III, aged 18-60 years) undergoing elective surgery were randomly allocated into two groups: Group A (C-E technique, n=35) and Group B (V-E technique, n=35). The primary outcome measured was expired Tidal Volume (TVe). Secondary outcomes included peak airway pressure (Pmax), ease of ventilation score, haemodynamic parameters, and ventilation failure rates. Data were analysed using unpaired t-tests for continuous variables and the Chi-square test for categorical variables. A p-value of <0.05 was considered statistically significant. Results: The groups were comparable in demographics (mean age: Group A-42.3±8.7 years vs. Group B-41.8±9.2 years, p-value=0.832; weight: 84.2±12.1 kg vs. 85.1±11.8 kg, p=0.751; BMI: 26.8±2.4 kg/m2 vs. 27.2±2.6 kg/m², p-value=0.513). The mean TVe was significantly higher in the V-E group (677.9±76.8 mL) compared to the C-E group (450.7±71.2 mL; p-value<0.001). Peak airway pressures were similar between groups (C-E: 21.5±1.8 cmH2 O vs. V-E: 20.3±1.6 cmH2 O; p-value=0.074). The ease of ventilation score was significantly better with the V-E technique (4.2±0.6 vs. 2.7±0.8; p-value<0.001). Ventilation failure occurred in five patients (14.3%) with the C-E technique and none with the V-E technique. Conclusion: The V-E technique provides superior ventilation with higher tidal volumes, better ease of ventilation, and lower failure rates compared to the C-E technique during mask ventilation. The V-E technique achieved 50% higher tidal volumes without requiring increased airway pressures, demonstrating superior ventilation efficiency. This technique should be preferentially used for two-handed mask ventilation in clinical practice.