Non-invasive ventilation (NIV) is used in patients with respiratory failure, sleep apnoea, and dyspnoea related to pulmonary oedema. NIV is provided through a facial mask. Many complications of NIV facial masks have been reported, including the breakdown of facial skin. We report a case of an elderly male admitted with multiple co-morbidities. The facial mask was applied continuously for NIV, without any relief or formal monitoring of the underlying skin. It resulted in a Grade II pressure ulcer. We discuss the possible mechanism and offer advice for prevention of such device-related pressure ulcers.

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Objective: To find out if the addition of Nitrous Oxide to Sevoflurane significantly reduces induction time and to study the effect of Nitrous Oxide on the frequency of adverse events during induction. Study Design: Quasi-experimental study Place and Duration of Study: Operation Theatre Complex, PAF Hospital Mushaf Sargodha Pakistan from Jul to Sep 2018. Methodology: One hundred adult indoor patients undergoing elective surgeries were included in the study. Their ages were from 18 to 34yrs, and all fell in ASA I and II category. In Group-A, 43 and Group- B, 57 patients were enrolled. Sevoflurane at a high concentration of 8% was given to all patients for induction. In Group-A, 100% oxygen was used as a vehicle, while in Group-B, 70% Nitrous Oxide and 30% oxygen were used as vehicles. Induction time was measured from switching Sevoflurane to when the patients’ arms fell horizontal. We documented adverse effects, including coughing, laryngospasm,bronchospasm, fall in SpO2 <94%, apnea, excitation (head or limb movements), bradycardia and arrhythmias were documented. Results: Mean induction time was 59.00±13.00s and 58.00±8.00s in Groups A and B, respectively. The difference was statistically insignificant (p-value=0.874). Similarly, there was no significant difference in adverse events between the two groups. Conclusion: We concluded that adding Nitrous Oxide has no clinically significant advantage in the induction of anaesthesia with Sevoflurane in adults.