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Difficult mask ventilation is defined as inability to maintain O2 sats >92% despite best of adjuncts and assistants.

Patients with difficult mask ventilation have 4 x the risk of difficult airway intubation.

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Oct 15, 2011
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Incidence and predictors of difficult and impossible mask ventilation.

Kheterpal S, et al. Show all Journal
Anesthesiology. 2006 Nov;105(5):885-91.

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May 03, 2013
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Prediction of Difficult Mask Ventilation
Langeron, Olivier M.D.;

Anesthesiology . 92(5):1229-1236, May 2000.

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If the patient is bearded plus at risk of difficult ventilation, consider having them shave their beard to improve the seal of the mask.

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Oct 15, 2011
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Performing a gas induction to "test ventilate" a patient who is at risk of difficult mask ventilation does not guarantee the patient will not obstruct their airway.

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Difficult mask ventilation can be predicted by the mnemonic MOAN

M- Mask Seal
O- Opening of the mouth (MP 3 or 4)
A- Apnea (OSA)
N- No Teeth or Neck Irradiation

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If difficulty creating a seal in the patient with a beard, evert the lower lip & lower the caudal rim of the facemask onto the exposed buccal mucosa, into the angle between the lip & inferior alveolar ridge. This forms a good seal around a significant part of the mask refl.in/cs

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If a big mask leak is present during an emergency, consider having someone hold down oxygen flush continuously for continuous high oxygen flows.

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Oct 07, 2011
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If you reach a can't intubate, can't ventilate scenario, switch into "crisis mode". Start a clock timer and determine at which time or oxygen saturation at which you'll proceed to cricothyroidotomy while other attempts at oxygenation or waking the patient are made. This starts the thought process early.

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