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\begin{document}

\title{Comparison of intra-oral mask and classic face mask in terms of
ventilation success and practitioners' work load assessments: a
randomized crossover study}



\author[1]{Mikail ALKAN}%
\author[1]{İsmail Aytaç}%
\author[1]{Betül GÜVEN AYTAÇ}%
\author[1]{Hidayet  ÜNAL}%
\author[1]{Bahattin  GÜRSUL}%
\author[1]{Semih Başkan}%
\author[1]{Aysun POSTACI}%
\author[1]{Nermin GÖĞÜŞ}%
\affil[1]{Ankara Numune Training and Research Hospital}%


\vspace{-1em}



  
  \date{May 25, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
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\selectlanguage{english}
\begin{abstract}
Aim: Providing effective ventilation of the unconscious patient is an
essential skill in every specialty dealing with airway management. In
this randomized cross-over study aimed to compare intra-oral and classic
face mask in terms of ventilation success of patients, practitioners'
workload and anxiety assessments. Also we analyzed potential risk
factors of difficult mask ventilation for both masks. Methods: 24
anesthesiology residents and 12 anesthesiologists participated in the
study. Each of the practitioners ventilated 4 patients with both masks
at settled pressure and frequency. Practitioners rated their workload
and anxiety related to masks with National Aeronautics and Space
Administration Task Load Index score and State Trait Anxiety Inventory
scale. Ventilation success was evaluated with Han scale, expiratory
tidal volume and leak volume. We analyzed potential risk factors of
difficult mask ventilation with anthropometric characteristics and
STOP-BANG score. Results: Ventilation success rate was superior with
intraoral mask comparing to classic face mask in terms of Han Scale
(Easy mask ventilation percentage 84/144 (58.3\%); 123/144 (85.4\%);
respectively) and tidal volume (481.92\selectlanguage{ngerman}±173.99; 430.85±154.87mL;
respectively). Leak volume in intraoral mask ventilation was
significantly lower than classic face mask (71.50±91.17 /159.38±146.31
respectively). Diffucult mask ventilation risk factors were high weight,
neck circumference, Mallampati score and STOP-BANG score\textgreater{}3
for classic face mask (at the utmost neck circumference 95\% CI,
OR=1.180, p= 0.002) Risk factors were high body mass index and
Mallampati score for intraoral mask (at the utmost Body mass index 95\%
CI, OR=1.162 p=0.006). The anxiety ratings of practitioners were similar
between two masks. The work-load rating is higher with intraoral mask
comparing to classic face mask. Conclusion: Intraoral mask may be an
effective alternative device for bag-valve mask ventilation.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\textbf{Comparison of intra-oral mask and classic face mask in terms of
ventilation success and practitioners' work load assessments: a
randomized crossover study}

\textbf{Aim:} Providing effective ventilation of the unconscious patient
is an essential skill in every specialty dealing with airway management.
In this randomized cross-over study aimed to compare intra-oral and
classic face mask in terms of ventilation success of patients,
practitioners' workload and anxiety assessments. Also we analyzed
potential risk factors of difficult mask ventilation for both masks.

\textbf{Methods:} 24 anesthesiology residents and 12 anesthesiologists
participated in the study. Each of the practitioners ventilated 4
patients with both masks at settled pressure and frequency.
Practitioners rated their workload and anxiety related to masks with
National Aeronautics and Space Administration Task Load Index score and
State Trait Anxiety Inventory scale. Ventilation success was evaluated
with Han scale, expiratory tidal volume and leak volume. We analyzed
potential risk factors of difficult mask ventilation with anthropometric
characteristics and STOP-BANG score.

\textbf{Results:} Ventilation success rate was superior with intraoral
mask comparing to classic face mask in terms of Han Scale (Easy mask
ventilation percentage 84/144 (58.3\%); 123/144 (85.4\%); respectively)
and tidal volume (481.92\selectlanguage{ngerman}±173.99; 430.85±154.87mL; respectively). Leak
volume in intraoral mask ventilation was significantly lower than
classic face mask (71.50±91.17 /159.38±146.31 respectively).

Diffucult mask ventilation risk factors were high weight, neck
circumference, Mallampati score and STOP-BANG score\textgreater{}3 for
classic face mask (at the utmost neck circumference 95\% CI, OR=1.180,
p= 0.002) Risk factors were high body mass index and Mallampati score
for intraoral mask (at the utmost Body mass index 95\% CI, OR=1.162
p=0.006).

The anxiety ratings of practitioners were similar between two masks. The
work-load rating is higher with intraoral mask comparing to classic face
mask.

\textbf{Conclusion:} Intraoral mask may be an effective alternative
device for bag-valve mask ventilation.

\textbf{Key words} : Difficult mask ventilation; Face mask; Han scale;
Intraoral mask; STOP BANG score

\textbf{1.INTRODUCTION AND AIM}

Providing effective ventilation of the unconscious patient during either
resuscitation or general anesthesia induction and wake-up period is an
essential skill in every specialty dealing with airway management.
Adequate mask ventilation has become an important focus in the difficult
airway algorithms' various stages \textsuperscript{1,2}.

Determining risk factors for difficult mask ventilation
(DMV)\textsuperscript{3} and providing preoxygenation
\textsuperscript{4}before induction of anesthesia considering the
possibility of DMV have utmost importance in operation theaters,
emergency and intensive care units (ICU) \textsuperscript{5}.

Classic Face mask (CFM) ventilation is frequently applied also during
non-operating room anesthesia, in or out-of hospital cardiac arrests
etc. by auxiliary medical personnel and specialists not as familiar as
anesthesiologists \textsuperscript{6}.

It is emphasized that healthcare workers responsible for airway
management should be familiar with different devices and techniques that
may have advantages in certain situations \textsuperscript{7}.

Although mask ventilation is life-saving and important, this topic has
been given little coverage in the widespread scientific literature and
book chapters on airway management \textsuperscript{8}.

An important cause of difficult mask ventilation is gas leakage from
improper seal besides resistance of the airway to the gas inlet or
outlet \textsuperscript{9}.

Improper seal between the CFM and the patient's face may occur because
of beard, facial anatomical deformity, toothlessness and etc.
Additionally facemasks somewhat increases dead space and may cause
insufficiency of tidal volume \textsuperscript{10}.

Practitioners commonly grasp the CFM with the thumb and index fingers in
the form of C and place the CFM on the face of the patient , while
raising the mandible with the other fingers in the form of E letter
although there are some alternative grips \textsuperscript{11} (Figure
1).

Intraoral mask (IOM) is an alternative mask which is placed in the mouth
between the lips and teeth like a snorkel. Practitioners close the nose
with the tips of the thumb and index finger then with other finger grasp
and raise the mandible and close the mouth. IOM may have advantages in
situations as improper seal with the CFM. IOM also may have some
advantages for preoxygenization and can be used for non-invasive
ventilation \textsuperscript{12-18} (Figure 2).

In this randomized observer blinded cross-over study we compared the IOM
and CFM (AMS) in terms of the effectiveness of ventilation and
practitioners' anxiety/workload evaluation related to the masks.
Secondly we aimed to investigate the factors likely to cause and
incidence of DMV for two masks.

\textbf{2. MATERIAL AND METHODS:}

After obtaining ethics committee approval (Ankara Numune Education and
Research Hospital Ethics Committee, numbered E-15-666 and dated
20/01/2016) and written informed consent from patients and
practitioners, this single-center, prospective, randomized,
observer-blinded cross-over study was conducted between January 2016 and
March 2016.

24 anesthesiology residents and 12 specialist anesthesiologists
participated in the study in the general surgery operation theatre. Each
of the practitioners ventilated 4 patients with non-dominant hand. Each
of the patients ventilated with IOM (NuMASK®) and CFM (AMS) at settled
pressure (20 cmH20) and frequency (12/min) with Dräger Perseus®
anesthesia device for one minute per mask. Application order of the
masks was determined by the closed envelope method. Mask ventilation
efficiency of 144 ASA I-II-III patients aged 18-65 years was evaluated.

The exclusion criteria of our study were as follows; initial SPO2 value
\textless{}95\%, severe pulmonary or cardiac diseases, tumor or goiter
restricting the airway, tooth mobility and SPO2\textless{}90\% during
mask ventilation for any reason

The State-Trait Anxiety Inventory TX-2 (Trait Anxiety Scale Scoring)
levels, age, gender, and years of anesthesia experience of the
participants were recorded.

In preoperative examination patient's name, protocol number, age,
gender, comorbidities, ASA score, Mallampati score, weight, height, Body
mass index (BMI), neck circumference(NC), thyromental distance (TMD),
sternomental distance (SMD), hyo-mental distance (HMD), interincisor
distance (IID), whether he had teeth, whether he had a beard, and
whether there was any limitation in neck movements were recorded.

The risk of Obstructive Sleep Apnea was determined with the STOP-Bang
Scoring Model \textsuperscript{19}. Patients who answered yes to 3 or
more questions were registered as high risk of OSAS (STOP\_BANG\selectlanguage{english}[?]3), and
patients who answered yes to less than 3 questions
(STOP\_BANG\textless{}3) were recorded as low risk of OSAS.

Anesthesia was induced with 0.05 mg.kg\textsuperscript{-1} midazolam,
1.0 mcg.kg\textsuperscript{-1} fentanyl, 2
mg.kg\textsuperscript{-1}propofol and 0.5mg.kg\textsuperscript{-1}
rocuronium after eight hours of fasting. Intraoperative noninvasive
blood pressure, electrocardiography, and SpO\textsubscript{2} were
performed. The patient was placed comfortably in the supine and sniffing
position. The practitioner firstly ventilated the patient for 1 minute
with the first randomly predetermined mask. Before the second mask, mask
ventilation was transferred to an assistant and the practitioner rested
for 1 minute. Then the practitioner ventilated for another one minute
with the second mask. During ventilation periods a blinded observer
recorded mean TV, mean end-tidal carbon dioxide (etCO2) levels,
SpO\textsubscript{2}and LV for both masks. The effectiveness of
ventilation of the masks were also assessed by another observer with the
Han Mask Ventilation scale\textsuperscript{20}. For Han scale=I (easy
ventilation) ventilation was considered successful. For Han
scale\textgreater{}I (II=Needs oral airway, III= requiring two care
providers, IV= unable to mask ventilate) ventilation was considered
successful.

After the 4th patient, practitioners completed the State-Trait Anxiety
Inventory TX-1 (State-Trait Anxiety Scale Scoring) form and the NASA-TLX
(The National Aeronautics and Space Administration-Task Load
Index)\textsuperscript{21} forms to measure their anxiety for IOM and
CFM. .

\textbf{3. STATISTICAL ANALYSIS}

Mean and Standard Deviation, Median, Minimum, Maximum values are given
in descriptive statistics for continuous data, and number and percentage
values are given in categorical data. SPSS 11.5 program was used in the
evaluations and p \textless{}0.05 was accepted as the statistical
significance limit.

Mann-Whitney U Test / T Test were used according to testing results of
the distribution normality for the data obtained by measurement.
Chi-Square Test / Fisher's Exact Test were used for categorical data.

Wilcoxon test / Paired Samples T test was used to compare the SPO2,
EtCO2, TV and LV measurements between two masks.

\textbf{4. RESULTS}

Demographic and anthropometric characteristics of the patients
summarized in Table 1.

Mean TV was higher and Median LW was lower in IOM comparing to CFM(Table
2) but SPO\textsubscript{2} and ETCO\textsubscript{2} were similar
between masks. Successful ventilation(Percentage of the patients with
Han Scale=1) were higher in IOM comparing to the CFM (Table 3)

Mean weight of the patients and median of the NC were higher in
unsuccessful mask ventilation(Han Scale\textgreater{}1) group for
CFM(p\textless{}0.05). Other demographic and anthropometric
characteristics were similar between successful and unsuccessful CFM
ventilation (Table 4).

Percentage of the patients with Mallampati I and Low OSAS risk
(STOP-BANG Score\textless{}3) were higher in successful CFM Ventilation.
Gender, ASA and Beard rates were similar between successful and
unsuccessful CFM ventilation (Table 5).

Mean BMI of the patients were higher in unsuccessful mask ventilation
(Han Scale\textgreater{}1) comparing to successful IOM ventilation
group. Other demographic and anthropometric characteristics were similar
between successful and unsuccessful IOM ventilation (Table6).

Percentage of the patients with Mallampati I was higher in successful
IOM Ventilation (Table 7) and Gender, ASA, OSAS risk and beard rates
were similar between successful and unsuccessful IOM ventilation.

There were no difference between anxiety ratings of practitioners
between using CFM and IOM. However practitioners rated the workload for
IOM higher in effort, mental demand sections and composite NASA-TLX
score than CFM (Table 8).

\textbf{5. DISCUSSION}

This study demonstrated that intraoral mask has more easy ventilation
rate than classic face mask according to Han Scale (123(85.4), 84(58.3);
n(\%); respectively; p=0.000). Also it has higher expiratory tidal
volume (481.92+-173.99, 430.85+-154.87 mL; respectively; p=0.000) and
decreased air leak volume (71.50+-91.17, 159.38+-146.31 mL; respectively;
p=0.000) than classic face mask.

There are very few studies in the scientific literature that discuss the
effectiveness of the intraoral mask \textsuperscript{12-15,17,22}. The
comparisons in terms of the effectiveness of masks in our study are
consistent with previous cadaver studies \textsuperscript{13,15,17,22}.

According to these results it can be assumed that intraoral mask may
have some advantages in difficult mask ventilation situations caused by
air leakage due to improper seal. Society of Airway Management
recommended using a well-sealed facemask with HEPA filter in suspected
COVID-19 patients for pre-oxygenation and
ventilation\textsuperscript{4}. It can be assumed that decreased air
leakage may result less aerosol formation and reduce the likelihood of
virus transmission in the COVID-19 era.

Secondly our study demonstrated that practitioners' situational anxiety
level obtained from STAI FORM TX1 were similar between intraoral and
classic face mask. Despite of these results workload measurements of the
practitioners with the~NASA task load index~(NASA TLX) were higher for
intraoral mask than classic facemask. This can be attributed to the
users not being familiar with the intraoral mask and their routine use
of the classic mask.

There are conflicting results in the literature regarding users'
evaluation of intraoral and classic masks. In the study of Riggle et
al.\textsuperscript{12} conducted on the airway training manikin, the
average muscle pain perceived by the practitioners for both masks was
statistically insignificant and most of the practitioners preferred the
classical mask; stated that it is easier to grasp, less fatigue and
easier to use with the classical mask. The practitioners' evaluations in
this study \textsuperscript{12} are consistent with the results of our
study.

However, in terms of workload, the results of our study are contradicted
by the fact that McCroy et al.\textsuperscript{13} found the workload of
the intraoral mask higher in their study. The reason for this situation
may be that practitioners may evaluate the workload of a real mask
ventilation application on the patient higher than the workload of a
mask ventilation scenario on a cadaver. In addition, in our study, each
doctor was given the opportunity to try the mask on 4 different patients
instead of a single cadaver, and this situation may have changed the
workload assessment due to encountering different patient
characteristics.

The main difference of our study from
others\textsuperscript{12,13,15,17,22} is that it was performed on real
patients under operating room conditions and both masks were used in a
large series of patients. Although there are many studies investigating
the risk factors for difficult mask ventilation in the
literature\textsuperscript{3,8,9}, to our knowledge our study is the
first study investigating these risk factors for intraoral mask together
with the classic mask in the same patient group. Since we have a large
patient series, we were able to secondarily investigate the predictors
of difficult mask ventilation for both of the masks. We comprehensively
investigated the risks of difficult mask ventilation, including the
STOP-BANG score, which evaluates the risk of obstructive sleep apnea
syndrome along with anthropometric features. The most significant factor
among the possible risks for difficult mask ventilation was the neck
circumference for the classical mask (other significant factors were
body weight, mallampati and stop-bang score). For NuMask the most
significant risk factor was BMI and the other was mallampati score. Our
results are compatible with a number of risk factors in studies
involving a larger number of patients for classic
mask\textsuperscript{3,9} and additionally determines risk factors for
intraoral mask.

However, there are many limited aspects of our study. It is an important
deficiency that the risk factors for difficult mask ventilation are
calculated according to the Han scale for patients with\textgreater{} I
(II = Needs oral airway, III = requiring two care providers) and do not
include real difficult mask ventilation. According to
Orbany\textsuperscript{23}, the aspects in which Han scale is limited;
not validated, not sensitive enough for data comparisons and research
purposes, and it is not reproducible. Evaluation is also subjective and
observer dependent. Orbany \textsuperscript{23} emphasized that there is
no standard definition of difficult mask ventilation based on precise
and objective criteria, therefore it is difficult to compare studies and
share clinical information. He points out that due to the subjective and
practitioner-dependent nature of success in mask ventilation, making
such a precise definition is also a difficult goal. However, the risk
factors found in our study when considered causally were rational and
this limitation is common in other studies \textsuperscript{8}.

\textbf{6. CONCLUSION}

Intraoral mask can be alternative in difficult mask ventilation
situations caused by air leakage due to improper seal. Teaching its use
during anesthesia training may lead to more positive results.

\textbf{REFERENCES}

1. Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society
2015 guidelines for management of unanticipated difficult intubation in
adults. \emph{BJA: British Journal of Anaesthesia.} 2015;115(6):827-848.

2. Gomez-Rios M, Gaitini L, Matter I, Somri M. Guidelines and algorithms
for managing the difficult airway. \emph{Revista Espanola de
Anestesiologia y Reanimacion (English Edition).} 2018;65(1):41-48.

3. Norskov A, Wetterslev J, Rosenstock C, et al. Prediction of difficult
mask ventilation using a systematic assessment of risk factors vs.
existing practice--a cluster randomised clinical trial in 94,006
patients. \emph{Anaesthesia.} 2017;72(3):296-308.

4. Foley LJ, Urdaneta F, Berkow L, et al. Difficult Airway Management in
Adult COVID-19 Patients: Statement by the Society of Airway
Management.\emph{Anesthesia \& Analgesia.} 2021:10.1213.

5. Higgs A, McGrath B, Goddard C, et al. Guidelines for the management
of tracheal intubation in critically ill adults. \emph{British journal
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6. Soleimanpour H, Gholipouri C, Panahi JR, et al. Role of
anesthesiology curriculum in improving bag-mask ventilation and
intubation success rates of emergency medicine residents: a prospective
descriptive study. \emph{BMC emergency medicine.} 2011;11(1):1-6.

7. Hagberg C, Gabel JC, Connis R. Difficult Airway Society 2015
guidelines for the management of unanticipated difficult intubation in
adults: not just another algorithm. In: Oxford University Press; 2015.

8. Nielsen JR, Lim K-S. Increasing the Scope on Difficult Airways: What
About Mask Ventilation? \emph{Anesthesia \& Analgesia.}2019;129(3):e109.

9. Sreekantha D, Saldanha RS, Krishnappa JG, Mehandale SG, Glen RRC,
Prajna M. Predicting difficulties in Mask Ventilation using Machine
Learning techniques. Paper presented at: 2019 IEEE International
Conference on Distributed Computing, VLSI, Electrical Circuits and
Robotics (DISCOVER)2019.

10. Botes L, Jacobs J, Rademeyer R, Van der Merwe S, Van Heerden L,
Diedericks B. The effect of different anaesthetic mask shapes on the
anatomical dead space using infant, child and adult part-task
trainers.\emph{Southern African Journal of Anaesthesia and
Analgesia.}2018;24(5):145-147.

11. Gerstein NS, Carey MC, Braude DA, et al. Efficacy of facemask
ventilation techniques in novice providers. \emph{Journal of clinical
anesthesia.} 2013;25(3):193-197.

12. Riggle JD, McCrory B, Wadman M, et al. Comparison of muscle exertion
and fatigue between standard bag valve mask and NuMask. Paper presented
at: Proceedings of the Human Factors and Ergonomics Society Annual
Meeting2012.

13. McCrory B, Lowndes BR, Thompson DL, et al. Workload comparison of
intraoral mask to standard mask ventilation using a cadaver model. Paper
presented at: Proceedings of the Human Factors and Ergonomics Society
Annual Meeting2012.

14. Nimmagadda U, Salem M, Hsu E, Knezevic NN. The New Mask Is as
Effective as the Classic Face Mask in Achieving Maximal Preoxygenation.

15. Amack AJ, Barber GA, Ng PC, Smith TB, April MD. Comparison of
ventilation with one-handed mask seal with an intraoral mask versus
conventional cuffed face mask in a cadaver model: a randomized crossover
trial. \emph{Annals of emergency medicine.} 2017;69(1):12-17.

16. Bach JR, Saporito LR. Cardiopulmonary Resuscitation Interface
Adapted for Postextubation Continuous Noninvasive Ventilatory
Support.\emph{American journal of physical medicine \&
rehabilitation.}2015;94(9):e80-e83.

17. McCrory B, Lowndes BR, Thompson DL, et al. Crossover assessment of
intraoral and cuffed ventilation by emergency responders. \emph{Military
medicine.} 2019;184(Supplement\_1):310-317.

18. Blake DF, Crowe M, Lindsay D, Brouff A, Mitchell SJ, Pollock NW.
Comparison of tissue oxygenation achieved breathing oxygen from a demand
valve with four different mask configurations. \emph{Diving and
hyperbaric medicine.} 2018;48(4):209.

19. Nagappa M, Wong J, Singh M, Wong DT, Chung F. An update on the
various practical applications of the STOP-Bang questionnaire in
anesthesia, surgery, and perioperative medicine. \emph{Current opinion
in anaesthesiology.} 2017;30(1):118.

20. Han R, Tremper KK, Kheterpal S, O'Reilly M. Grading scale for mask
ventilation. \emph{The Journal of the American Society of
Anesthesiologists.} 2004;101(1):267-267.

21. Hart SG, Staveland LE. Development of NASA-TLX (Task Load Index):
Results of empirical and theoretical research. In: \emph{Advances in
psychology.} Vol 52. Elsevier; 1988:139-183.

22. Coule P, Mazzoli A, Todaro J. 465: Comparison of a Novel Intra-Oral
Mask (NuMask(r)) to Standard Mask Ventilation Using a Cadaver
Model.\emph{Annals of Emergency Medicine.} 2010;3(56):S150-S151.

23. El-Orbany M, Woehlck HJ. Difficult mask ventilation.\emph{Anesthesia
\& analgesia.} 2009;109(6):1870-1880.

\textbf{Table 1:} Demographic and anthropometric characteristics of the
patients\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
Parameter\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
Mean \selectlanguage{ngerman}± SD\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
Med(Min-Max)\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
Parameter\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
n(\%)\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Age(y)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
42.94\selectlanguage{ngerman}±13.24\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
43 (18-78)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{Gender(F/M)}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
71/73(49.3/50.7)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Weight(kg)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
77.93\selectlanguage{ngerman}±12.73\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
77 (50-123)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{ASA I/II/III}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
22/121/1(15.3/84/0.7)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Height(cm)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
169.51\selectlanguage{ngerman}±7.70\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
170 (150-187)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{Mallampati I/II/III}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
49/74/21(34/51.4/14.6)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
BMI(kg.cm\textsuperscript{-2})\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
26.73\selectlanguage{ngerman}±4.41\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
26 (18-41)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\textbf{Low OSAS risk (STOP-BANG\textless{}3)}\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
107(74.3)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
NC(cm)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
37.62\selectlanguage{ngerman}±3.50\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
37.50 (28-48)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
\textbf{High OSAS risk} \textbf{(STOP-BANG\textgreater{}3)}\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
37(25.7)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
TMD(cm)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7.66\selectlanguage{ngerman}±1.24\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
8 (4-12)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
SMD(cm)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
15.40\selectlanguage{ngerman}±1.67\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
15.5 (12-19)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
HMD(cm)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5.49\selectlanguage{ngerman}±1.03\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5.50 (2-9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
IID(cm)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4.67\selectlanguage{ngerman}±0.71\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5 (3-7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Data are expressed as mean \selectlanguage{ngerman}± standard deviation or number (percentage).
BMI, Body mass index ;NC, neck circumference; TMD, thyromental distance;
SMD, sternomental distance; HMD, hyo-mental distance; IID, interincisor
distance

\textbf{Table 2:} Comparison of the effectiveness of the ventilation
between CFM and IOM in terms of SpO2\%, EtCO2, TV and LV.\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
& Classic Face Mask & Classic Face Mask & Intraoral Mask & Intraoral
Mask &\tabularnewline
\midrule
\endhead
& \selectlanguage{ngerman}\textbf{Mean ± SD} & \textbf{Med(Min-Max)} & \selectlanguage{ngerman}\textbf{Mean ± SD} &
\textbf{Med (Min-Max)} & \textbf{p\textsuperscript{+}}\tabularnewline
SpO\textsubscript{2} & 99.46\selectlanguage{ngerman}±0.88 & 100 (96-100) & 99.44\selectlanguage{ngerman}±0.93 & 100
(96-100) & 0.572\tabularnewline
EtCO\textsubscript{2} & 33.81\selectlanguage{ngerman}±4.32 & 34 (6-44) & 33.59\selectlanguage{ngerman}±4.35 & 33 (3-45)
& 0.175\tabularnewline
TV & 430.85\selectlanguage{ngerman}±154.87 & 430 (100-850) & 481.92\selectlanguage{ngerman}±173.99 & 500 (50-910) &
\textbf{0.000*}\tabularnewline
LV & 159.38\selectlanguage{ngerman}±146.31 & 110 (0-720) & 71.50\selectlanguage{ngerman}±91.17 & 40 (0-470) &
\textbf{0.000*}\tabularnewline
\bottomrule
\end{longtable}

\textsuperscript{+}Wilcoxon test/ Paired Samples T test; *
\textless{}0.05 (SD, Standard deviation, Min; Minimum, Max; Maximum,
SpO\textsubscript{2} peripheral oxygen saturation, ETCO2 End tidal
carbondioxyde, TV; Expiratory tidal volume, LV Leak volume)

\textbf{Table 3:} Comparison of the Classic face mask and Intraoral mask
in terms of the ventilation success using the Percentage of the Patients
with Han Scale=I\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
& Successful ventilation for Classic face mask & Successful ventilation
for Intraoral mask &\tabularnewline
\midrule
\endhead
Han Scale =I & 84(58.3) & 123(85.4) &
\textbf{0.000\textsuperscript{*}}\tabularnewline
\bottomrule
\end{longtable}

Data are expressed as number (percentage) \textsuperscript{*}McNemar
Test p\textless{}0.005

\textbf{Table 4:} Comparison of patient characteristics between
successful (Han Scale=1) and unsuccessful mask ventilation (Han Scale
\textgreater{}1) in classic face mask ventilation\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
& Successful Classic Face Mask Ventilation (Han Scale=1) n=84 (58.3\%) &
Successful Classic Face Mask Ventilation (Han Scale=1) n=84 (58.3\%) &
Unsuccessful Classic Face Mask Ventilation (Han Scale\textgreater{}1)
n=60 (41.7\%) & Unsuccessful Classic Face Mask Ventilation (Han
Scale\textgreater{}1) n=60 (41.7\%) &\tabularnewline
\midrule
\endhead
Parameter & \selectlanguage{ngerman}\textbf{Mean ± SD} & \textbf{Med(Min-Max)} & \selectlanguage{ngerman}\textbf{Mean ±
SD} & \textbf{Med(Min-Max)} & \textbf{p}\tabularnewline
Age(y) & 41.19\selectlanguage{ngerman}±12.37 & 40 (18-70) & 45.38\selectlanguage{ngerman}±14.13 & 46 (20-78) &
0.061\tabularnewline
Weight(kg) & 75.67\selectlanguage{ngerman}±12.30 & 75 (50-123) & 81.10\selectlanguage{ngerman}±12.74 & 80 (50-113) &
\textbf{0.011+}\tabularnewline
Height(cm) & 168.73\selectlanguage{ngerman}±7.49 & 168 (150-187) & 170.62\selectlanguage{ngerman}±7.93 & 170 (155-185) &
0.147\tabularnewline
BMI(kg.cm\textsuperscript{-2}) & 26.18\selectlanguage{ngerman}±4.13 & 26 (19-37) & 27.50\selectlanguage{ngerman}±4.69 &
27 (18-41) & 0.076\tabularnewline
NC(cm) & 36.83\selectlanguage{ngerman}±3.17 & 36.5 (28-45) & 38.73\selectlanguage{ngerman}±3.66 & 38 (32-48) &
\textbf{0.002*}\tabularnewline
TMD(cm) & 7.63\selectlanguage{ngerman}±1.25 & 8 (4-10) & 7.70\selectlanguage{ngerman}±1.22 & 8 (5-12) &
0.923\tabularnewline
SMD(cm) & 15.32\selectlanguage{ngerman}±1.65 & 15.5 (12-19) & 15.52\selectlanguage{ngerman}±1.70 & 15.5 (12-19) &
0.628\tabularnewline
HMD(cm) & 5.43\selectlanguage{ngerman}±1.02 & 6 (2-7) & 5.57\selectlanguage{ngerman}±1.05 & 5 (3-9) &
0.673\tabularnewline
IID(cm) & 4.68\selectlanguage{ngerman}±0.76 & 5 (3-7) & 4.66\selectlanguage{ngerman}±0.65 & 5 (4-7) &
0.781\tabularnewline
\bottomrule
\end{longtable}

\textsuperscript{\textbf{+}} T Test/ *Mann-Whitney U Test for
p\textless{}0.005 (SD, Standard deviation, Min; Minimum, Max; Maximum;
BMI, Body mass index ;NC, neck circumference; TMD, thyromental distance;
SMD, sternomental distance; HMD, hyo-mental distance; IID, interincisor
distance)

\textbf{Table 5:} Comparison of patient characteristics between
successful (Han Scale=1) and unsuccessful mask ventilation (Han Scale
\textgreater{}1) in classic face mask ventilation\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
\begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
Successful Classic Face Mask Ventilation (Han Scale=1) n=84
(58.3\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
Unsuccessful Classic Face Mask Ventilation (Han Scale\textgreater{}1)
n=60 (41.7\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
P+\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
P+\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
P+\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Gender(F/M)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
43/41(51,2/48.8)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
28/32(46.7/53.3)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.592\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.592\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.592\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
ASA I/II/III\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
17/66/1(20.2/78.6/1.2)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
5/55/0(8.3/91.7/0)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.076\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.076\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.076\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Mallampati I/II/III\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
36/38/10(42.9/45.2/11.9)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
13/36/11(21.7/60/18.3)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{0.029*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{0.029*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{0.029*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Low OSAS risk (STOP-BANG\textless{}3) High OSAS risk
(STOP-BANG\textgreater{}3)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
71(84.5) 13(15.5)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
36(60) 24(40)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{0.001*}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{0.001*}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{0.001*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Beardless Only Mustache Beard\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
73(86.9) 8(9.5) 3(3.6)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
45(75) 11(18.3) 4(6.7)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.163\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Data are expressed as number (percentage) F, Female; M, Male; OSAS,
Obstructive Sleep Apnea Syndrome +Ki Kare Test/ Fisher's Exact Test
*p\textless{}0.05

\textbf{Table 6:} Comparison of patient characteristics between
successful (Han Scale=1) and unsuccessful mask ventilation (Han Scale
\textgreater{}1) in intraoral mask ventilation\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
& Successful Intraoral Mask Ventilation (Han Scale=1) n=123 (58.3\%) &
Successful Intraoral Mask Ventilation (Han Scale=1) n=123 (58.3\%) &
Unsuccessful Intraoral Mask Ventilation (Han Scale\textgreater{}1) n=21
(41.7\%) & Unsuccessful Intraoral Mask Ventilation (Han
Scale\textgreater{}1) n=21 (41.7\%) &\tabularnewline
\midrule
\endhead
Parameter & \selectlanguage{ngerman}\textbf{Mean ± SD} & \textbf{Med(Min-Max)} & \selectlanguage{ngerman}\textbf{Mean ±
SD} & \textbf{Med(Min-Max)} & \textbf{p}\tabularnewline
Age(y) & 42.18\selectlanguage{ngerman}±13.34 & 43 (18-78) & 47.38\selectlanguage{ngerman}±11.99 & 48 (29-71) &
0.096\tabularnewline
Weight(kg) & 77.15\selectlanguage{ngerman}±12.19 & 77 (50-123) & 82.48\selectlanguage{ngerman}±15.03 & 80 (50-113) &
0.076\tabularnewline
Height(cm) & 170.02\selectlanguage{ngerman}±7.68 & 170 (150-187) & 166.52\selectlanguage{ngerman}±7.32 & 165 (155-180) &
0.054\tabularnewline
BMI(kg.cm\textsuperscript{-2}) & 26.29\selectlanguage{ngerman}±4.23 & 26 (18-37) & 29.29\selectlanguage{ngerman}±4.67 &
29 (19-41) & \textbf{0.004\textsuperscript{+}}\tabularnewline
NC(cm) & 37.60\selectlanguage{ngerman}±3.43 & 38 (28-48) & 37.76\selectlanguage{ngerman}±3.97 & 37 (32-45) &
0.858\tabularnewline
TMD(cm) & 7.60\selectlanguage{ngerman}±1.21 & 8 (4-12) & 8.0\selectlanguage{ngerman}±1.34 & 8 (6-12) &
0.331\tabularnewline
SMD(cm) & 15.47\selectlanguage{ngerman}±1.71 & 16 (12-19) & 15.0\selectlanguage{ngerman}±1.34 & 15 (13-18) &
0.166\tabularnewline
HMD(cm) & 5.43\selectlanguage{ngerman}±1.02 & 5 (2-7) & 5.81\selectlanguage{ngerman}±1.08 & 6 (4-9) &
0.251\tabularnewline
IID(cm) & 4.67\selectlanguage{ngerman}±0.72 & 5 (3-7) & 4.67\selectlanguage{ngerman}±0.66 & 5 (4-6) &
0.958\tabularnewline
\bottomrule
\end{longtable}

\textsuperscript{+}T Test p\textless{}0.005; (SD; Standard deviation,
Med; Median, Min; Minimum, Max; Maximum, BMI; Body mass index, NC; neck
circumference, TMD; thyromental distance; SMD, sternomental distance;
HMD, hyo-mental distance; IID, interincisor distance)

\textbf{Table 7:} Comparison of patient characteristics between
successful (Han Scale=1) and unsuccessful mask ventilation (Han Scale
\textgreater{}1) in intraoral mask ventilation\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
\begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
Successful Intraoral Mask Ventilation(Han Scale=1) n= 123 (85.4\%)\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
Unsuccessful Intraoral Mask Ventilation(Han Scale\textgreater{}1) n=21
(14.6\%)\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
P+\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
P+\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
P+\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Gender(F/M)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
57/66(46.3/53.7)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
14/7(66.7/33.3)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.085\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.085\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.085\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
ASA I/II\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
21/102/0(17.1/82.9/0)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1/19/1(4.8/90.5/4.8)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.064\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.064\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.064\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Mallampati I/II/III\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
46/62/15(37.4/50.4/12.2)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
3/12/6(14.3/57.1/28.6)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{0.043*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{0.043*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{0.043*}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Low OSAS risk (STOP-BANG\textless{}3) High OSAS risk
(STOP-BANG\textgreater{}3)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
93(75.6) 30(24.4)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
14(66.7) 7(33.3)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.386\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.386\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.386\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Beardless Only Mustache Beard\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
100(81.3) 17(13.8) 6(4.9)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
18(85.7) 2(9.5) 1(4.8)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0.894\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Data are expressed as number (percentage) F, Female; M, Male; OSAS,
Obstructive Sleep Apnea Syndrome +Ki Kare Test/ Fisher's Exact Test
*p\textless{}0.05

\textbf{Table 8:} Comparison of the anxiety and workload assessment of
the practitioners with STAI and NASA-TLX for Classical face mask and
Intraoral mask\selectlanguage{english}
\begin{longtable}[]{@{}llllllllll@{}}
\toprule
& Classic Face Mask & Classic Face Mask & IntraOral Mask & IntraOral
Mask & IntraOral Mask & IntraOral Mask & & &\tabularnewline
\midrule
\endhead
& \selectlanguage{ngerman}\textbf{Mean ± SD} & \textbf{Med(Min-Max)} & \textbf{Med(Min-Max)} &
\selectlanguage{ngerman}\textbf{Mean ± SD} & \selectlanguage{ngerman}\textbf{Mean ± SD} & \textbf{Med(Min-Max)} &
\textbf{Med(Min-Max)} & \textbf{p\textsuperscript{+}} &
\textbf{p\textsuperscript{+}}\tabularnewline
STAI-TX1 & 29.56\selectlanguage{ngerman}±6.59 & 27.5 (20-44) & 31.67\selectlanguage{ngerman}±8.13 & 31.67\selectlanguage{ngerman}±8.13 & 30.5
(20-50) & 30.5 (20-50) & 0.052 & 0.052 &\tabularnewline
Nasa-TLX Total & 28.11\selectlanguage{ngerman}±5.59 & 27 (14-42) & 31.17\selectlanguage{ngerman}±8.69 & 31.17\selectlanguage{ngerman}±8.69 & 29
(16-52) & 29 (16-52) & \textbf{0.009*} & \textbf{0.009*}
&\tabularnewline
NASA-Mental Demand & 3.53\selectlanguage{ngerman}±1.71 & 3 (1-8) & 4.19\selectlanguage{ngerman}±2.34 & 4.19\selectlanguage{ngerman}±2.34 & 4
(1-10) & 4 (1-10) & \textbf{0.009*} & \textbf{0.009*} &\tabularnewline
NASA-Physical Demand & 5.06\selectlanguage{ngerman}±2.14 & 5 (1-10) & 5.39\selectlanguage{ngerman}±2.37 & 5.39\selectlanguage{ngerman}±2.37 & 5
(1-10) & 5 (1-10) & 0.294 & 0.294 &\tabularnewline
NASA-Temporal Demand & 4.03\selectlanguage{ngerman}±2.14 & 3 (1-10) & 4.36\selectlanguage{ngerman}±2.38 & 4.36\selectlanguage{ngerman}±2.38 & 4
(1-10) & 4 (1-10) & 0.268 & 0.268 &\tabularnewline
NASA-Effort & 4.25\selectlanguage{ngerman}±1.71 & 4.5 (1-8) & 5.08\selectlanguage{ngerman}±2.38 & 5.08\selectlanguage{ngerman}±2.38 & 5 (1-10) &
5 (1-10) & \textbf{0.019*} & \textbf{0.019*} &\tabularnewline
NASA-Performance & 8.39\selectlanguage{ngerman}±1.64 & 9 (2-10) & 8.75\selectlanguage{ngerman}±1.18 & 8.75\selectlanguage{ngerman}±1.18 & 9
(6-10) & 9 (6-10) & 0.106 & 0.106 &\tabularnewline
NASA-Frustration & 2.94\selectlanguage{ngerman}±1.41 & 3 (1-8) & 3.50\selectlanguage{ngerman}±2.08 & 3.50\selectlanguage{ngerman}±2.08 & 3 (0-9)
& 3 (0-9) & 0.080 & 0.080 &\tabularnewline
\bottomrule
\end{longtable}

NASA-TLX; The National Aeronautics and Space Administration-Task Load
Index, STAI-TX1; State Trait Anxiety Inventory, SD; Standard Deviation,
Min; Minimum, Max; Maximum ( \textsuperscript{+}Wilcoxon test; *
p\textless{}0.05)

\textbf{Figure 1} : Classical Face Mask Ventilation

\textbf{Figure 2:} Intraoral Mask Ventilation\selectlanguage{english}
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