Management of a Difficult Airway With Direct Ventilation Through Nasal Airway Without Facemask

Abstract

Mask ventilation is a key component of airway management for oral surgeons and anesthesia care providers. Clinicians often encounter a difficult airway in which adequate mask ventilation may be difficult or impossible. Difficult mask ventilation has been described as the inability for an experienced anesthesiologist to provide adequate face mask ventilation because of one or more of the following problems: inadequate mask seal, excessive gas leak, or excessive resistance to the ingress or egress of gas. 1 Although the exact pathogenesis of the difficult airway is not clearly defined, the presence of upper airway obstruction has been demonstrated to be the key contributor. Risk factors for difficult mask ventilation and upper airway obstruction correlate well and include increased age, obesity, and history of snoring or sleep apnea. 2,3 Relaxation of the upper airway musculature during sleep or anesthesia also contributes to upper airway obstruction and difficult mask ventilation. 1,3,4 The loss of upper airway muscle tone combined with the gravitational pull on the tongue and soft palate have been shown to result in airway collapse. 3-6 It is therefore logical to assume that creation of a patent upper airway would improve mask ventilation. This principle has been demonstrated in a recent study comparing oro-nasal mask ventilation and nasal mask ventilation, 7 as well as in this report. Report of a Case