Difficult Mask Ventilation

Abstract

Mask ventilation is the most fundamental skill in airway management. In this review, we summarize the current knowledge about difficult mask ventilation (DMV) situations. Various definitions for DMV have been used in the literature. The lack of a precise standard definition creates a problem for studies on DMV and causes confusion in data communication and comparisons. DMV develops because of multiple factors that are technique related and/or airway related. Frequently, the pathogenesis involves a combination of these factors interacting to cause the final clinical picture. The reported incidence of DMV varies widely (from 0.08% to 15%) depending on the criteria used for its definition. Obesity, age older than 55 yr, history of snoring, lack of teeth, the presence of a beard, Mallampati Class III or IV, and abnormal mandibular protrusion test are all independent predictors of DMV. These signs should, therefore, be recognized and documented during the preoperative evaluation. DMV can be even more challenging in infants and children, because they develop hypoxemia much faster than adults. Finally, difficult tracheal intubation is more frequent in patients who experience DMV, and thus, clinicians should be familiar with the corrective measures and management options when faced with a challenging, difficult, or impossible mask ventilation situation.

Test ventilation: time to relax?

“…Montague et al described the placement of nasopharyngeal airways and Jaques catheters under direct vision using the GlideScope TM (Verathon Medical United Kingdom Ltd, High Wycombe, UK) in patients having cleft palate repair [1]. Likewise, Gordon et al Used the GlideScope to inspect the airway, with minimal stimulation, following facial reconstructive surgery [2]. Similarly, we have found the Airtraq TM Optical Laryngoscope (Prodol Meditec SA, Vizcaya, Spain) of use following thyroid surgery.…”

“…As they point out, the use of a non-Luer connector would not have prevented this error [2]. I would like to commend a simple 10-step systems solution for minimising the chance of this happening in future: Patel suggests that test ventilation may lighten anaesthesia and promote difficulty.…”

Conscious Sedation and Awake Fiberoptic Intubation in a Patient with Difficult Mask Ventilation—A Case Report

“…Every anesthesiologist should acquire the skills for mask ventilation [1]. DMV is a situation in which it is not possible for the anesthesiologist to provide adequate face mask ventilation due to an inadequate mask seal, excessive gas leakage or excessive resistance to ingress or egress of gas [3].…”

“…It includes difficult intubation (DI), difficult mask ventilation (DMV) or both. Since mask ventilation is a basic fundamental skill in airway management, every anesthesiologist should acquire skills for mask ventilation and should be knowledgeable about the causes of DMV and consider alternative options including oropharyngeal airway, nasopharyngeal airway, laryngeal mask airway, transtracheal jet ventilation, cricothyrotomy, and awake fiberoptic intubation (AFOI) when the mask ventilation is difficult [1]. Mask ventilation is the first step of airway management before endotracheal intubation or insertion of any airway devices.…”

Anaesthetic management of acute airway obstruction

“…Independent predictors for difficult face mask ventilation are: obesity, aged 55 years and above, history of snoring, lack of teeth, the presence of a beard, Mallampati Class III or IV, and abnormal mandibular protrusion test. (18) Predictors for difficult intubation include: decreased interdental and thyromental distances, increased Mallampati scores, and decreased neck movement. (19,20) One study demonstrated 12 independent predictors of combined difficult face mask ventilation and laryngoscopy: aged 46 years and above; body mass index ≥ 30; male gender; Mallampati Class III or IV; neck mass or radiation changes; limited thyromental distance; sleep apnoea; limited cervical spine mobility; limited jaw protrusion; thick neck; presence of teeth; and beard.…”