An Experience with Manual Ventilation in Respiratory Paralysis Due to Indian Common Krait (Bungarus Caeruleus) Bite

Background: Bungarus caeruleus (common krait) bite during monsoon season is common in northwest India. Respiratory failure is responsible for high mortality in the victims. In this study we report our experience with manual ventilation using bag valve mask (BVM) in patients with neuroparalysis due to common krait bite.  Methods:This prospective study was conducted between June 2009 and December 2009. All consecutive patients with diagnosis of common krait bite who were manually ventilated by BVM were studied. The duration of ventilation and complications associated with ventilation were noted. Polyvalent anti snake venom was administered as per the "national snake bite protocol" and patients were followed up until final outcome. Results: Thirty-four patients (70.6% men) were studied. All patients except two came from rural areas and they were hospitalized between June and September. Majority of patients were bitten during the night while sleeping on the floor. The mean time interval between bite and arrival to hospital was 4.4 hours. Ptosis (100%) was he most common clinical finding followed by ophtalmoplegia (80%) and limb muscle weakness (74%). Twenty-four patients (70%) developed respiratory symptoms and 20 (59%) were intubated and manually ventilated by BVM. Mean duration of assisted ventilation was 34.6 ± 12.8 hours. Hoarseness of voice and throat pain were noted in all intubated patients following extubation, which responded to conservative therapeutic measures. The mean duration of hospitalization was 6 ± 1.6 days. All patients except one survived. Conclusion: Manual ventilation with BVM in patients with neuroparalysis due to common krait bite is a safe and effective modality in resource constraint settings.