We read the editorial by Shih-Yi Lee et al. on “Prospective view for mask design” with a great interest (1). In the article, the authors have proposed a new mask design for difficult mask ventilation (DMV). We would like to suggest them take the risk factors of difficult intubation (DI) into consideration into the design of novel masks, because both DMV and DI possibly cause difficult airways, though the risk factors between DMV and DI are different in some ways (2-5).
Both mask ventilation and trachea intubation are used to secure the airway of patients, and the DMV and DI risk their lives, especially in critical condition during resuscitation. DMV increases the risk of procedure-related eye and eyelid injury, nerve injury, gastric insufflation, aspiration, vomiting, and over-inflation; on the other hand, DI may cause dental injuries, esophageal trauma, laryngeal damage, and hoarseness, which physicians need to take care of when encountering DI (6).
Airway management maneuvers and techniques, face mask adjuncts, intubating laryngeal mask airway, nasal mask ventilation, and tracheostomy are current ways to resolve the problems caused by DMV (1,7). Advanced techniques such as fiberoptic intubation with/without positive pressure ventilation have been suggested for DI (8,9). A new mask should be designed to resolve the problems caused by DMV and DI that both results in difficult airways.
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- Lee SY, Kuo CY, Wei DH, et al. Prospective view for mask design. Health Technol 2017;1:3. [Crossref]
- Langeron O, Masso E, Huraux C, et al. Prediction of difficult mask ventilation. Anesthesiology 2000;92:1229-36. [Crossref] [PubMed]
- Cho J, Cho YS, You JS, et al. Current status of emergency airway management for elderly patients in Korea: Multicentre study using the Korean Emergency Airway Management Registry. Emerg Med Australas 2013;25:439-44. [PubMed]
- Lee SY, Shih SC, Leu YS, et al. Implications of age-related changes in anatomy for geriatric-focused difficult airways. Int J Gerontol 2017;11:130-133. [Crossref]
- Lee SY, Chien DK, Huang MY, et al. Patient-specific factors associated with difficult mask ventilation in the emergency department. Int J Gerontol 2017;11:263-6. [Crossref]
- Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth 1994;41:372-83. [Crossref] [PubMed]
- Takaishi K, Kawahito S, Tomioka S, et al. Cuffed oropharyngeal airway for difficult airway management. Anesth Prog 2014;61:107-10. [Crossref] [PubMed]
- Collins SR, Blank RS. Fiberoptic intubation: an overview and update. Respir Care 2014;59:865-78; discussion 878-80. [Crossref] [PubMed]
- Aoyama K, Yasunaga E, Takenaka I, et al. Positive pressure ventilation during fibreoptic intubation: comparison of the laryngeal mask airway, intubating laryngeal mask and endoscopy mask techniques. Br J Anaesth 2002;88:246-54. [Crossref] [PubMed]
Cite this article as: Lin HC, Lu CC. Difficult airways for advanced mask design. Health Technol 2019;3:12.