The Proussaefs Maneuver
The Proussaefs maneuver was introduced to treat desaturated hyperventilating or non-breathing patients who are experiencing respiratory depression.
With proper respiratory monitoring (i.e. pretracheal stethoscope and/or capnography) clinicians shall be able to detect respiratory depression before oxygen desaturation occurs.
The Proussaefs maneuver has been introduced to clinicians as an immediate reaction to clinical situations where undetected respiratory depression has resulted to a suspected oxygen desaturation. It is proposed as the first reaction a clinician might demonstrate any time the pulse oximeter indicates a reading below 90.
With the described maneuver, a clinician can simultaneously provide head tilt, jaw thrust, listen to patient’s respiratory sounds, observe patient’s chest movements, and look at the monitor.
Description of the Proussaefs maneuver:
When an oxygen desaturation is suspected (i.e. pulse oximeter readings start to be below 90), the clinician needs to follow the following steps:
Step 1: With your forearm, immediately provide head tilt maneuver. By utilizing your forearm
and not the hand, this enables you to simultaneously use your hand to provide a jaw thrust maneuver. Tt the same time, keep all fingers on both hands in tight contact ready to provide jaw thrust maneuver.
Step 2: Use your index fingers to provide jaw thrust maneuver. By keeping all fingers in tight
contact this provides then needed support to the index fingers to complete the jaw thrust maneuver. Please the index fingers at the two corners of the mandible. This will provide a stimulus to an oversedated patient to initiate independent breaths. Push the mandible forward; this will open the airway and assist the patient in ventilating.
Step 3: Tilt your head and place you ear close the to patient’s nose and mouth.
This will enable you to listen to the patient breathing (or confirm not breathing). If not breathing is confirmed, then proceed with the O.P.T.I.M.A.A.L. technique. While listening to the patient’s breathing status, observe the patient’s chest for respiratory movements (or efforts) and at the same time keep looking at the monitors
Dr. Proussaefs has been applying this technique for more than 10 years for every patient experiencing signs of respiratory depression. The Proussaefs maneuver has been taught at the California Institute of Dental Education for more than 5 years, and it has been applied by clinicians who have followed Dr. Proussaefs courses in adult oral sedation.
To schedule a dental procedure using the Proussaefs maneuver, please call (805) 676-1063 or contact one of our previous alumni of the CIDE adult oral sedation certification course who have been implementing the Proussaefs maneuver:
Previous Alumni of the CIDE adult oral sedation certification course who have been implementing the Proussaefs maneuver:
Kevin Chou DDS, general dentist, Bakersfield, CA
Anna Durkin, general dentist, San Marcos, CA
Sherwin Matian, DMD, general dentist, West Hollywood, CA
Sarah Bukhari DDS, MS, Board certified prosthodontist, Redlands, CA
Abdulaziz AlHelal, Board certified prosthodontist, Loma Linda, CA
Ali Jazayeri DDS, general dentist, Mission Viejo, CA
Jeremy Sewell DMD, Temecula, CA
Sergio Ocampo DDS, La Miranda, CA
Dara Kimia DMD, Granada Hills, CA
Laura Fathi DDS, general dentist, Thousand oaks, CA
Raedh Alhwadi DDS, Merced, CA
Norma Lantzsch DDS, Riverside, CA
John Magnis DDS, Diplomate, American Board of Oral Implantology, Oxnard, CA
Kathy Patmore DDS, endodontist, Sanat Barbara, CA
Warren Gerosa, general dentist, Los Angeles, CA
Pat Emigh DDS, general dentist, Long Beach, CA
Pedram Fakheri DDS, periodontist, Los Angeles, CA
Tom Lim DDS, general dentist, Camarillo, CA
John Nerwinski DDS, general dentist, Las Vegas, NV
Jeffrey Rafaiski DDS, general dentist, El Cajon, CA
Irina Rodriguez, general dentist, Ojai, CA
Deven Rawlani DDS, general dentist, Pune, India
Suraj Sharma, general dentist, Riverside, CA
Keep four fingers tight to better support the jaw thrust movement.
Simultaneous with the jaw thrust movement place your index fingers at the corner mandible and
Frontal view of the maneuver.
At the same time, observe patient's chest movements and keep and eye on the monitor.
Place the tips of your index fingers at the corner of the mandible and push the mandible forward.
View of the maneuver above the Head
Position your head so that your ear stays next to the patient's nose and Mouth.
Audit any breath sounds
The Proussaefs maneuver, an overview