- Email: [email protected]
Effective nasal mask ventilation of a difficult airway in a patient with advanced salivary gland cancer
Journal of Clinical Anesthesia 39 (2017) 108–109
Contents lists available at ScienceDirect
Journal of Clinical Anesthesia
Correspondence Effective nasal mask ventilation of a difficult airway in a patient with advanced salivary gland cancer Keywords: Nasal mask ventilation Difficult airway McGRATH™ MAC
To the Editor, We report a case of successful nasal mask ventilation in a patient with a difficult airway and advanced salivary cancer. A 41-year-old man (176 cm, 66 kg) diagnosed with salivary cancer was scheduled for cervical lymph node resection under general anesthesia. As he could open his mouth sufficiently and no mass was seen in the lower jaw, mask ventilation was sufficient and tracheal intubation was performed uneventfully with a Macintosh laryngoscope. Three weeks after the first operation, he was scheduled for resection of a metastatic lung tumor under general anesthesia. This time, metastasis was suspected in the angle of the mandible, so mask holding with an E-C
clamp was contraindicated. His mouth opening was insufficient due to the metastasis (3 cm), so both difficult mask ventilation and intubation were anticipated. Because the patient did not consent to awake intubation, we decided to perform nasal mask ventilation. After continuous remifentanil and propofol administration, we put a pediatric-sized face mask around the patient's nose and performed mask ventilation (Fig. 1). After sufficient visual chest confirmation, we administered rocuronium as a muscle relaxant. Then, we performed tracheal intubation with a 35 Fr double-lumen tracheal tube using the McGRATH™ MAC (McGRATH; Aircraft Medical Ltd., U.K.) videolaryngoscope [1,2]. The difficult airway in the second surgery was attributed to the advanced salivary cancer that had developed in the angle of the mandible. Nasal mask ventilation has been reported as useful for effective mask ventilation [3,4]. Our experience suggests the utility of nasal mask ventilation using a smaller mask in patients for whom ventilation cannot be performed by holding the mandible.
Conflict of interest None.
Fig. 1. Nasal mask ventilation in the patient.
http://dx.doi.org/10.1016/j.jclinane.2017.03.034 0952-8180/© 2017 Elsevier Inc. All rights reserved.
Correspondence
Author contributions S.M., N.K., and M.S. performed critical management of the case and prepared the manuscript. T.M. prepared the manuscript, provided critical comments, and approved the final version for submission. Patient consent Written consent to publish this report was obtained from the patient. References [1] Kido H, Komasawa N, Matsunami S, Kusaka Y, Minami T. Comparison of McGRATH MAC and Macintosh laryngoscopes for double-lumen endotracheal tube intubation by anesthesia residents: a prospective randomized clinical trial. J Clin Anesth 2015; 27:476–80. [2] Mihara R, Komasawa N, Matsunami S, Minami T. Comparison of direct and indirect laryngoscopes in vomitus and hematemesis settings: a randomized simulation trial. Biomed Res Int 2015;2015:806243.
109
[3] Liang Y, Kimball WR, Kacmarek RM, Zapol WM, Jiang Y. Nasal ventilation is more effective than combined oral-nasal ventilation during induction of general anesthesia in adult subjects. Anesthesiology 2008;108:998–1003. [4] Jiang Y, Bao FP, Liang Y, Kimball WR, Liu Y, Zapol WM, et al. Effectiveness of breathing through nasal and oral routes in unconscious apneic adult human subjects: a prospective randomized crossover trial. Anesthesiology 2011;115:129–35.
Sho Masuda, MD Nobuyasu Komasawa, MD, PhD* Megumi Sakai, MD Toshiaki Minami, MD, PhD Department of Anesthesiology, Osaka Medical College, Japan *Corresponding author at: Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka 569-8686, Japan. E-mail address: [email protected] (N. Komasawa). 7 March 2017
Contents lists available at ScienceDirect
Journal of Clinical Anesthesia
Correspondence Effective nasal mask ventilation of a difficult airway in a patient with advanced salivary gland cancer Keywords: Nasal mask ventilation Difficult airway McGRATH™ MAC
To the Editor, We report a case of successful nasal mask ventilation in a patient with a difficult airway and advanced salivary cancer. A 41-year-old man (176 cm, 66 kg) diagnosed with salivary cancer was scheduled for cervical lymph node resection under general anesthesia. As he could open his mouth sufficiently and no mass was seen in the lower jaw, mask ventilation was sufficient and tracheal intubation was performed uneventfully with a Macintosh laryngoscope. Three weeks after the first operation, he was scheduled for resection of a metastatic lung tumor under general anesthesia. This time, metastasis was suspected in the angle of the mandible, so mask holding with an E-C
clamp was contraindicated. His mouth opening was insufficient due to the metastasis (3 cm), so both difficult mask ventilation and intubation were anticipated. Because the patient did not consent to awake intubation, we decided to perform nasal mask ventilation. After continuous remifentanil and propofol administration, we put a pediatric-sized face mask around the patient's nose and performed mask ventilation (Fig. 1). After sufficient visual chest confirmation, we administered rocuronium as a muscle relaxant. Then, we performed tracheal intubation with a 35 Fr double-lumen tracheal tube using the McGRATH™ MAC (McGRATH; Aircraft Medical Ltd., U.K.) videolaryngoscope [1,2]. The difficult airway in the second surgery was attributed to the advanced salivary cancer that had developed in the angle of the mandible. Nasal mask ventilation has been reported as useful for effective mask ventilation [3,4]. Our experience suggests the utility of nasal mask ventilation using a smaller mask in patients for whom ventilation cannot be performed by holding the mandible.
Conflict of interest None.
Fig. 1. Nasal mask ventilation in the patient.
http://dx.doi.org/10.1016/j.jclinane.2017.03.034 0952-8180/© 2017 Elsevier Inc. All rights reserved.
Correspondence
Author contributions S.M., N.K., and M.S. performed critical management of the case and prepared the manuscript. T.M. prepared the manuscript, provided critical comments, and approved the final version for submission. Patient consent Written consent to publish this report was obtained from the patient. References [1] Kido H, Komasawa N, Matsunami S, Kusaka Y, Minami T. Comparison of McGRATH MAC and Macintosh laryngoscopes for double-lumen endotracheal tube intubation by anesthesia residents: a prospective randomized clinical trial. J Clin Anesth 2015; 27:476–80. [2] Mihara R, Komasawa N, Matsunami S, Minami T. Comparison of direct and indirect laryngoscopes in vomitus and hematemesis settings: a randomized simulation trial. Biomed Res Int 2015;2015:806243.
109
[3] Liang Y, Kimball WR, Kacmarek RM, Zapol WM, Jiang Y. Nasal ventilation is more effective than combined oral-nasal ventilation during induction of general anesthesia in adult subjects. Anesthesiology 2008;108:998–1003. [4] Jiang Y, Bao FP, Liang Y, Kimball WR, Liu Y, Zapol WM, et al. Effectiveness of breathing through nasal and oral routes in unconscious apneic adult human subjects: a prospective randomized crossover trial. Anesthesiology 2011;115:129–35.
Sho Masuda, MD Nobuyasu Komasawa, MD, PhD* Megumi Sakai, MD Toshiaki Minami, MD, PhD Department of Anesthesiology, Osaka Medical College, Japan *Corresponding author at: Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka 569-8686, Japan. E-mail address: [email protected] (N. Komasawa). 7 March 2017