Comparison of Three Facemask Ventilation Maneuvers in Anesthetized Adults: A Randomized Crossover Study

Background: Facemask ventilation (FMV) is a critical skill in airway management. Although the two-handed triple airway maneuver is often regarded as the gold standard, its complexity may limit consistent application in clinical practice. Aim: This study aimed to compare the ventilation efficacy of the one-handed E–C technique, two-handed jaw-thrust, and two-handed triple airway maneuver performed with a thenar eminence (E–V) grip in anesthetized adults. Methods: In this prospective, randomized, crossover study, 14 adult patients (American Society of Anesthesiologists I–III) undergoing elective surgery were enrolled in this study. After induction of general anesthesia and neuromuscular blockade, each patient underwent three FMV techniques in randomized order: one-handed E–C (Vt1), two-handed jaw-thrust (Vt2), and two-handed triple airway maneuver (Vt3). Tidal volumes (TVs) were recorded for each technique. Because the data were non-normally distributed, the Friedman test and the Wilcoxon signed-rank test with Bonferroni correction were applied. Results: The Friedman test showed a significant difference in TVs among techniques ( χ 2 = 16.57, P < 0.001). Both two-handed maneuvers produced significantly higher median TVs than the one-handed E–C technique (Vt1: 421.0 [347.0–468.5] mL vs. Vt2: 569.0 [496.3–628.5] mL; Vt3: 563.0 [489.3–626.3] mL; both P = 0.001). No significant difference was observed between Vt2 and Vt3 ( P = 0.57). Conclusion: Two-handed FMV techniques are markedly superior to the traditional one-handed E–C technique. A two-handed jaw-thrust using an E–V grip is as effective as the full triple airway maneuver and represents a simplified, equally efficacious option, particularly valuable in patients with cervical spine limitations.