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Upside-Down Mask Ventilation Technique for a Patient With a Long and Narrow Mandible
Takuro SanukiDDS, PhD,
Toshihiro WatanabeDDS,
Yu OzakiDDS,
Mizuki TachiDDS, PhD,
Kensuke KiriishiDDS,
Gaku MishimaDDS,
Mari KawaiDDS, PhD,
Ichiro OkayasuDDS, PhD,
Shinji KurataDDS, PhD, and
Takao AyuseDDS, PhD
Article Category: Other
Volume/Issue: Volume 61: Issue 4
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.4.169
Page Range: 169 – 170

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. 1 , 2 The long and narrow mandible is a commonly encountered mandibular anomaly. In patients with a long and narrow mandible, the gaps between the corners of the mouth and the lower corners of the mask are likely to prevent an adequate seal, and a gas leak may occur. When we administer general

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Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways
M. B RosenbergDMD,
J. C PheroDMD, and
D. E BeckerDDS
Article Category: Other
Volume/Issue: Volume 61: Issue 3
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.3.113
Page Range: 113 – 118

This article reviews the evolution and use of advanced airway devices, specifically supraglottic airways (SGAs), with the emphasis on the laryngeal mask airway (LMA), as the next intervention in difficult airway and ventilation management after bag-mask ventilation has been attempted. Management of the unexpected difficult airway during deep sedation and general anesthesia remains the most important aspect in avoiding mortality and morbidity because of the severe consequences of inadequate ventilation and oxygenation, especially in out

Essentials of Airway Management, Oxygenation, and Ventilation: Part 1: Basic Equipment and Devices
Daniel E. Becker,
Morton B. Rosenberg, and
James C. Phero
Article Category: Other
Volume/Issue: Volume 61: Issue 2
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.2.78
Page Range: 78 – 83

%. Hypoxemic respiratory drive plays a small role in patients with COPD. Studies have demonstrated that in patients with both acute and chronic hypercarbia, the administration of supplemental oxygen does not reduce minute ventilation . 2 DEVICES FOR POSITIVE PRESSURE SUPPLEMENTAL AND CONTROLLED VENTILATION Every dental office must have the ability to deliver oxygen with positive pressure. This may be accomplished with either oxygen-powered resuscitators (eg, Robertshaw or Elder Demand Valves) or with resuscitation bag-valve-mask (BVM

Figure 3.; Ventilation with the upside-down mask technique for the patient with a long and narrow mandible.
Takuro Sanuki,
Toshihiro Watanabe,
Yu Ozaki,
Mizuki Tachi,
Kensuke Kiriishi,
Gaku Mishima,
Mari Kawai,
Ichiro Okayasu,
Shinji Kurata, and
Takao Ayuse
Figure 3.
Figure 3.

Ventilation with the upside-down mask technique for the patient with a long and narrow mandible.

Figure 3.  ; Exemplary resuscitation bag manometers. Resuscitation bag manometers provide 3 colored zones indicating pressure being delivered during bag ventilation: (a) 0–20 cm H2O (green), safe for bag mask ventilation with or without oropharyngeal or nasopharyngeal airways; (b) 20–40 cm H2O (yellow), safe for bag ventilation with advanced airway (SGA or endotracheal tube); and (c) >40 cm H2O (red) unsafe pressure due to potential barotrauma.
M. B Rosenberg,
J. C Phero, and
D. E Becker
<bold>Figure 3. </bold>
Figure 3. 

Exemplary resuscitation bag manometers. Resuscitation bag manometers provide 3 colored zones indicating pressure being delivered during bag ventilation: (a) 0–20 cm H2O (green), safe for bag mask ventilation with or without oropharyngeal or nasopharyngeal airways; (b) 20–40 cm H2O (yellow), safe for bag ventilation with advanced airway (SGA or endotracheal tube); and (c) >40 cm H2O (red) unsafe pressure due to potential barotrauma.

Figure 3.  ; Bag-valve-mask with reservoir. Top left: Tubing is connected to an oxygen source with 15 L/min supplied to the device and entering the reservoir bag while the ventilation bag is compressed. When the ventilation bag is released, it expands and oxygen within the reservoir is sucked into the ventilation bag filling it with oxygen for the next compression. In some models the reservoir bag is replaced with tubing that functions similarly. Ventilation bag sizes vary from approximately 250 mL for neonates to approximately 500 mL for children and approximately 1500 mL for adults. Top right: It is recommended that bag-valve-mask (BVM) resuscitation bags are equipped with manometers that monitor ventilation pressure. Bottom left and right: One- and two-person BVM ventilations illustrate the proper mask seal using the so-called C-E technique. The mask is sealed with the thumb and first finger forming a “C” configuration over the mask, and the remaining fingers (“E”) are placed under the mandible enhancing the seal and pulling the head into a tilted position.
Daniel E. Becker,
Morton B. Rosenberg, and
James C. Phero
<bold>Figure 3. </bold>
Figure 3. 

Bag-valve-mask with reservoir. Top left: Tubing is connected to an oxygen source with 15 L/min supplied to the device and entering the reservoir bag while the ventilation bag is compressed. When the ventilation bag is released, it expands and oxygen within the reservoir is sucked into the ventilation bag filling it with oxygen for the next compression. In some models the reservoir bag is replaced with tubing that functions similarly. Ventilation bag sizes vary from approximately 250 mL for neonates to approximately 500 mL for children and approximately 1500 mL for adults. Top right: It is recommended that bag-valve-mask (BVM) resuscitation bags are equipped with manometers that monitor ventilation pressure. Bottom left and right: One- and two-person BVM ventilations illustrate the proper mask seal using the so-called C-E technique. The mask is sealed with the thumb and first finger forming a “C” configuration over the mask, and the remaining fingers (“E”) are placed under the mandible enhancing the seal and pulling the head into a tilted position.

Figure 5.  ; Comparison of classic LMA (left side) versus i-gel (right side). Four beneficial features of i-gel not found in the classic LMA: (a) does not require air inflation to seal over the glottis; (b) tip does not flex forward or backward preventing seal over the glottis; (c) vents gastric pressure if prior bag mask ventilation has pressurized the stomach; and (d) has a bite block to prevent loss of airway if patient bites down during return to consciousness while still needing airway management and ventilation assistance.
M. B Rosenberg,
J. C Phero, and
D. E Becker
<bold>Figure 5. </bold>
Figure 5. 

Comparison of classic LMA (left side) versus i-gel (right side). Four beneficial features of i-gel not found in the classic LMA: (a) does not require air inflation to seal over the glottis; (b) tip does not flex forward or backward preventing seal over the glottis; (c) vents gastric pressure if prior bag mask ventilation has pressurized the stomach; and (d) has a bite block to prevent loss of airway if patient bites down during return to consciousness while still needing airway management and ventilation assistance.

Figure 6.  ; i-gel supraglottic airway. (A) i-gel slightly moved down to show correct placement for seal over glottis permitting pressures up to 40 cm H2O without pressurization of stomach during ventilation. (B) i-gel patient placement with maxillary central incisors at the black line.
M. B Rosenberg,
J. C Phero, and
D. E Becker
<bold>Figure 6. </bold>
Figure 6. 

i-gel supraglottic airway. (A) i-gel slightly moved down to show correct placement for seal over glottis permitting pressures up to 40 cm H2O without pressurization of stomach during ventilation. (B) i-gel patient placement with maxillary central incisors at the black line.

Ventilation via Cut Nasotracheal Tube During General Anesthesia
Yoshinao AsahiDDS, PhD,
Shiro OmichiDDS, PhD,
Seita AdachiDDS, PhD,
Hajime KagamiuchiDDS, PhD, and
Junichiro KotaniDDS, PhD
Article Category: Other
Volume/Issue: Volume 60: Issue 1
Online Publication Date: Jan 01, 2013
DOI: 10.2344/11-00031.1
Page Range: 11 – 14

tube sometimes interferes with dental procedures that need to be performed with precision, particularly those involving proper occlusion of the teeth. It is difficult to master the technique of using FLMA as a nasal airway. 9 We evaluated a nasal device as a possible substitute for the FLMA and hypothesized that effective ventilation would be possible with a nasotracheal tube with an inflated cuff inserted to a position very close to the epiglottis. We investigated the effectiveness of ventilation using a cut nasotracheal tube (CNT) placed in the pharynx to

AirWay Scope™ for Difficult Ventilation in a Patient With Epiglottic Cyst
Takeo SugitaDDS, PhD and
Hirofumi ArisakaMD, DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 65: Issue 3
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-66-01-03
Page Range: 204 – 205

Epiglottic cysts are a rare cause of airway obstruction and often cause difficulty with airway management that can be potentially life threatening. We report a patient with an epiglottic cyst in whom laryngoscopy was performed with an AirWay Scope™ (AWS; TMAWS-S100; Pentax, Japan) due to difficulty in maintaining ventilation after induction of anesthesia, leading to improved ventilation and clarifying the cause of airway obstruction. The patient was a 62-year-old man (164-cm tall and weighing 53 kg). He had required nasal continuous