Trick of the trade: Face mask ventilation in edentulous patients

Can you imagine trying to bag-valve-mask ventilating this patient without teeth?

Edentulous patients can cause BVM problems because air tends to leak out the sides of the mouth, because the cheeks don't contact the mask as well. You can do a jaw-thrust and/or place an oropharyngeal airway to help. What else can you do?

Trick of the trade:

"Lower lip" face mask repositioning

Reposition the mask more superiorly to improve the BVM seal. Normally the inferior edge of the mask sites between the lower lip and chin alveolar ridge. Move the mask a 2-3 cm more superiorly.

In an Anesthesiology publication, the authors prospectively studied 49 edentulous patients in the OR who had a BVM seal leak. The provider then repositioned the face mask more superiorly so that the inferior border of the mask sits just below the lower lip.

Median air leak volume:

• Traditional BVM technique: 400 cc leak
• Lower lip face-mask technique: 10 cc leak

It's important to use the 2-handed (instead of 1-handed) BVM technique to supplement the lower-lip face mask repositioning trick.

Thanks to Chris at Life In The Fast Lane for letting me know about this cool trick just published!

Reference
Racine SX, Solis A, Hamou NA, Letoumelin P, Hepner DL, Beloucif S, & Baillard C (2010). Face mask ventilation in edentulous patients: a comparison of mandibular groove and lower lip placement. Anesthesiology, 112 (5), 1190-3 PMID: 20395823

.