Sir,
We read with interest the article published in J Anaesthesiol Clin Pharmacol 2016;32:412-4. Abrar et al. used inverted mask ventilation in a postrhinoplasty patient. Using EC position of the hand, the authors used a standard silicon anatomical face mask of size 3 which was rotated 180°, placed upside down with nasal end resting over the neck and the opposite lower end of the mask placed over the upper lip. The lateral sides of the mask were fitted snugly over the side of the neck which avoided the nose altogether and a good seal was achieved.[1]
Mask ventilation is an essential skill in the airway management. After rhinoplasty, nasal packs are generally used for maintaining hemostasis and stabilization of reconstructed nose. Breathing is only possible through mouth after endotracheal extubation in these patients because nostrils are completely blocked. In addition, using a standard face mask can spoil the surgical result because of compression of fragile nose. Further, it is difficult to obtain a good seal using standard face mask due to plaster splint and dressing.[2]
We would like to add one more technique for ventilation in these patients, which we have used. We used Rendell Baker Soucek mask for mouth ventilation in a postrhinoplasty patient after extubation of the trachea. The mask was placed over the mouth and a good seal was achieved with which we were able to ventilate the patient successfully. Rendell Baker Soucek mask has been designed for use in pediatric patients because of low dead space and good seal around contours of the cheek and chin. However, it can be used for nasal or mouth mask ventilation in adult patients.[3] In our case, it became a savior when we could not use standard face mask.
In our experience, this technique of ventilation using Rendell Baker Soucek mask is simple and effective. It can be used for nasal as well as mouth mask ventilation in situations of difficult or impossible conventional mask ventilation.
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Conflicts of interest
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References
- 1.Abrar SS, Taneja B, Saxena KN, Varughese SA. Inverted mask ventilation in a postrhinoplasty patient: Our experience. J Anaesthesiol Clin Pharmacol. 2016;32:412–4. doi: 10.4103/0970-9185.188826. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Erbay H, Kara CO, Kara IG, Tomatir E. Breathing or ventilation via a mouth mask for rhinoplasty operations in the early postanaesthetic period. Eur J Anaesthesiol. 2003;20:759. doi: 10.1017/s0265021503241235. [DOI] [PubMed] [Google Scholar]
- 3.Saini S, Bansal T. Anesthetic management of difficult airway in a patient with massive neurofibroma of face: Utility of Rendell Baker Soucek mask and left molar approach for ventilation and intubation. J Anaesthesiol Clin Pharmacol. 2013;29:271–2. doi: 10.4103/0970-9185.111735. [DOI] [PMC free article] [PubMed] [Google Scholar]