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Ventilation with the upside-down mask technique for the patient with a long and narrow mandible. Figure 1. The conventional method and the upside-down mask technique.
Source publication
Abstract Mask ventilation, along with tracheal intubation, is one of the most basic skills for managing an airway during anesthesia. Facial anomalies are a common cause of difficult mask ventilation, although numerous other factors have been reported. The long and narrow mandible is a commonly encountered mandibular anomaly. In patients with a long...
Contexts in source publication
Context 1
... we administer general anesthesia for these patients, we sometimes try to seal the airway using several sizes and shapes of commercially available face masks. We have found that management of the airway for patients with facial anomalies may be accomplished by attaching a mask upside down (see Figure 1). ...
Context 2
... we administer general anesthesia for these patients, we sometimes try to seal the airway using several sizes and shapes of commercially available face masks. We have found that management of the airway for patients with facial anomalies may be accomplished by attaching a mask upside down (see Figure 1). ...
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Background:
During preoxygenation, the lack of tight fit between the mask and the patient's face results in inward air leak preventing effective preoxygenation. We hypothesized that non-invasive positive-pressure ventilation and positive end-expiratory pressure (PEEP) could counteract inward air leak.
Methods:
Healthy volunteers were randomly as...
LMA CTrach™, a newer airway conduit, with its ability to ventilate and intubate is the ideal device for airway management for difficult airways. A retrospective study was conducted to evaluate the efficacy of this airway device in patients with anticipated difficult airway. 250 patients in whom LMA CTrach™ was used for endotracheal intubation was a...
Citations
... These have been shown in many studies to be high BMI, male gender, high modified Mallampati value, advanced age, presence of a beard, and absence of teeth. [19][20][21][22] In our study, the relationship between BMI and face mask ventilation was statistically significant in 542 adult patients, and the relationship between male gender and face mask ventilation was also statistically significant. The risk of difficult mask ventilation was also significantly higher in patients with an increased modified Mallampati class and a thyromental distance of less than 6 cm. ...
Objective:
Ensuring airway patency and proper management of ventilation by anticipating difficulties that can occur in airway control are vital in preventing anaesthesia-related complications. We aimed to determine the role of preoperative assessment findings in difficult airway management.
Methods:
In this study, critical incident records of difficult airway patients between 2010 and 2020 in the operating room of Bursa Uludag˘ University Medical Faculty were retrospectively analysed. A total of 613 patients, whose records were fully accessible, were grouped as paediatric (under 18 years old) and adult (18 years and over).
Results:
The success rate for maintaining an airway in all patients was 98.7%. Pathological situations which cause difficult airways were head and neck region malignancies in adult patients and congenital syndromes in paediatric patients. Anatomical reasons that cause difficult airway were anterior larynx (31.1%) and short muscular neck (29.7%) in adult patients and small chin (38.0%) in paediatric patients. A significant statistical relationship was found between difficult mask ventilation and increased body mass index, male gender, modified Mallampati class 3-4, and thyromental distance <6 cm (P = .001, P < .001, P < .001, and P < .001, respectively). The correlation of Cormack-Lehane grading with modified Mallampati classification, upper lip bite test, and mouth opening distance was statistically significant (P < .001, P < .001, and P < .001, respectively).
Conclusion:
In male patients with increased body mass index, modified Mallampati test class of 3-4 and thyromental distance of < 6 cm should suggest the possibility of difficult mask ventilation. In modified Mallampati classification and upper lip bite tests, the possibility of difficult laryngoscopy should be considered as class increases and mouth opening distance becomes shorter. Preoperative assessment, including a good history taken from the patient and a complete physical examination, is crucial to provide solutions for difficult airway management.
... Long and narrow mandible is a common facial anomaly. Cavities formed at the corners of the mouth and lower corners of the mask may cause air leak and DMV (19,20). In a study assessing the effect of horizontal ML on endotracheal intubation difficulty, a ML <9 cm was determined to be a predictive factor for difficult intubation (p<0.001) ...
Aim:The aim of our study was to evaluate specific factors in predicting difficult mask ventilation (DMV) in obese patients undergoing elective surgery.Methods:This prospective and observational study was performed in 90 obese patients. We assessed age, height, weight, sex, body mass index (BMI), dental structure, presence of facial hair, modified Mallampati test result, mouth opening, thyromental distance (TMD), sternomental distance, mandibular protrusion, mandibular length, neck circumference (NC), neck length, upper lip bite test result, height to TMD ratio, NC to TMD ratio (NC/TMD), and history of snoring and Obstructive Sleep Apnea syndrome for estimation of DMV.Results:The mean age of the patients was 40.9±9.4 years and the mean BMI was 44.7±6.2 kg/m2. Of all patients 38.9% were determined to have DMV. Clinical variables associated with DMV were male gender, mandibular length, snoring, NC, and NC/TMD. Multiple logistic regression analysis showed that male gender (p=0.047) and snoring (p=0.02) were independent factors.Conclusion:We believe that NC/TMD and ML are predictive tests for DMV in obese patients. Tests and measurements at the bedside are not sufficient alone and we believe that they will be more reliable when considered together.
... The ability to achieve adequate mask seal is thus a significant first step in difficult airway algorithm [2]. Any tumour [3,4], or deformity [5], or injury on the face [6] will impose difficulty in obtaining airtight mask seal for bag-mask ventilation. We would like to share our experience of such a situation in patient with 'Proboscisnose' due to a giant rhinophyma hanging in front of nares. ...
... Holding facemask may be difficult in presence of facial swelling or deformity particularly in and around the nose and lip as was in our patient. The use of various types and sizes of facemasks [3], and different techniques to achieve adequate mask seal have been reported [4,5]. Our patient large 'Proboscis nose' likely to limit the fitting of the conventional anatomical facemask, but once we could get a good airtight seal with the use of largest size facemask and reverse orientation we could get airtight seal of facemask and unobstructed bag-mask ventilation. ...
Rhinophyma is painless benign swelling due to hypertrophy of the sebaceous gland of the face and nose in
particular. In a neglected case, it presented as ‘Proboscis-nose’. As it was hanging in front of nose it was
compromising breathing ability of the patient during sleep. It was posing difficulty in placing normal size anstomical face-mask. We placed naso-pharyngeal airway under local anesthesia to retain nasal patency and largest size facemask (size-5) in a manner that it’s air filled cushion was kept deflated and wide mandibular arch was placed nasally to encase the swelling inside mask and then cushion was inflated to make it air tight fit on face. This helped us to get airtight fitting of the anatomical face mask and through nasopharyngeal airway allowed ventilation of the lungs during induction of general anesthesia before intubation. Rest of management and orotracheal intubation was achieved uneventful. We suggest use of nasal and oropharyngeal air way use and reverse uses of large facemask to attain bag-mask ventilation during induction of anesthesia in such cases.
Providing various levels of sedation to pediatric patients undergoing invasive, complex, and otherwise painful dental procedures involves a multifactorial level of treatment planning. Numerous considerations, including intraoperative bleeding, significant surgical stimulation, and impaired access to the pediatric airway are potential hazards and increase risks when performing these procedures outside of traditional, high-resource hospital operating room settings. Judicious administration of local anesthesia intraorally and to the surrounding oral cavity can facilitate surgery and reduce the anesthetic and analgesic demands in the perioperative and postoperative period as well. However, with the close proximity of the surgical field to the pediatric airway, precautions are required in the assessment and preoperative phase to ensure these types of dental procedures are accomplished with maximum safety in nontraditional settings. Despite other chapters (refer to Chaps. 4 and 24) exhaustively covering the important aspects of preoperative evaluation and pharmacologic strategies used in dental sedation, this chapter will explore some of the more common painful and invasive pediatric dental procedures with accompanying precautions and specific sedation and anesthetic considerations.
