facemask and nasopharyngeal airway

1. FACEMASKS, ORAL AND NASAL
AIRWAYS
DR. SHADAB

2. INTRODUCTION
• Facemask is an interference
device between the patient’s
upper airway and the breathing
system.
• It allows gas administration to
the patient from the breathing
system without introducing any
apparatus into the patient's
mouth.
• They may be made up of
antistatic material to prevent
ignition of anaesthetic gases.

3. DESCRIPTION
Face masks may be made up of:
-Black Rubber,
-Clear Plastic,
-Elastomeric Materia or Disposable Plastic or
-Combination of these.

4. PARTS OF FACEMASK
Body ( Shell or Dome)
• Constitutes the main
part of the mask
• Transparent facemask
allows observation for
vomitus, secretions ,
blood, lip color, and
exhaled moisture and is
better accepted by a
conscious patient .

5. Seal (Rim, Flap, Edge)
It comes in contact with the face.
Pad (cushion) type seal
Inflated with air or filled with a
material that will conform to the
face when pressure is applied.
Flap type seal
Flexible extension of the body
that conforms to the contour of
the face. It is pressed onto the
face to create a seal.

6. Connector (Orifice,
Collar, Mount)
• Present at the opposite
side from the seal.
• Has a thickened fitting
with a 22-mm internal
diameter.
• A ring with hooks may be
placed around the
connector to allow a mask
strap to be attached.

7. Face mask-types
1) Anatomical mask
Black rubber
Latex
Plastic
2) Ambu transparent mask
3) Rendell-Baker- Soucek mask

8. ANATOMICAL BLACK RUBBER FACE
MASK
• Also called
as Connell
mask.
• Body is
made of
rubber that
can be
widened or
narrowed to
fit the face
• Available in
sizes 0, 1, 2,
3 & 4.

9. Snuggy Silicone and black rubber
Facemask
Size Use
0 Infant
1 Small Child
2 Child
3 Small Adult
4 Adult
5 Large Adult
• It is autoclavable soft contoured cuff snug facemasks
• its provides patient’s comfort as well as makes for easy cleaning.
• The one piece construction and silicone rubber also allows for
clear view of presence of vomit, patient’s lip color as well as other
oral secretions.

10. EcoMask™
• It is a non-PVC single-use anatomical facemasks.
• It has clearer version of the traditional, reusable rubber face mask
- Non-slip rings for a better grip and tighter seal
- Anatomical shape, soft seal for a comfortable fit
- Transparent shell for excellent visibility
- available in a range of seven sizes with distinct colour-coding for
easy selection.

11. Trimar Mask
 It is similar to Connell mask.
 It has shallower body & less dead space
Trimar Mask

12. AMBU TRANSPARENT MASK
Made of
transparent
plastic with
inflatable
cuff for a
seal and
has thumb
rest built
into the
body

13. RENDELL-BAKER-SOUCEK MASK
• Designed for the pediatric
patients,
• Has a triangular body.
• Usually available in sizes 00, 0, 1
& 2
• Has a low dead space i.e.
4ml in size 1 &
8ml in size 2
• Adequately fits the child’s face
& no special seal is needed.
• Some of these masks are
scented and may have a pacifier

14. RBS MASKS-(A) CLEAR PLASTIC VERSION,(B) WITH
PACIFIER,©BLACK RUBBER VERSION.

15. SCENTED MASKS
• ROUND TYPE SILICONE
PAEDIATRIC MASKS
uses scents to camouflage the
odors of inhalational agents

16. Laerdal Peadiatric Mask
 It is made of silicon
rubber
 It has an inward curving
circular face seal
 It can be boiled or
autoclaved
 It has been found to be
better for ventilation of
newborn & paediatric
patients

17. Endoscopic Masks
• An endoscopic mask is
designed to allow mask
ventilation while an
endoscope is being used
• Port/diaphragm in the
mask body allows a
fiberscope to be
inserted into the nose or
mouth.
• A tracheal tube
previously loaded over
the fiberscope can then
be advanced, if desired.

18. Hudson’s Face Mask
It is made of clear plastic & is transparent
 On sides there are air entrainment holes
 It is variable performance mask (i.e FiO2 delivered is
O2 flow dependant)

19. •It is under-the-chin
design for excellent fit
on a wide variety of
face sizes.
•Clear, soft vinyl for
patient comfort and
visual patient
assessment.
•Adjustable nose clip
assures comfortable fit.
•Complete with 7 feet
oxygen supply tubing.
Method O2 flow
(l/min)
Estimated
FiO2(%)
Face mask 1 24
2 28
3 32
4 36
5 40
6-7 50
7-8 60
Facemask with
reservoir
6 60
7 70
8 80
9 90
10 95

20. TECHNIQUES OF USE
• Smallest mask that is appropriate is the most
desirable as it will cause:
-least increase in dead space
-easiest to hold
-less likely to result in pressure on the eyes.

21. One-hand Method
• Mask is holded by dominant hand and placed over
the bridge of the nose and on the chin
• The thumb and index finger of the dominant hand
are placed on the mask body and these finger
slightly push downwards to hold the mask to the
face and prevent leak.
• The remaining three fingers are placed on bony part
of the mandible to pull the mandible up into the
mask
• Use the free hand to squeeze the reservoir bag

22. The middle and ring finger is placed on the mandibular ridge to pull
the jaw backward and extend the neck.
Little finger is placed under the angle of the jaw and pull jaw upward
Digital pressure in region of sub mental triangle is avoided as
it can push the tongue up to the roof & increases obstruction.

23. Two-handed Method
• Mask is placed over the bridge of the nose and on
the chin
• index finger and thumb distal phalanges of both
hand is placed along the ridges of the mask
• The remaining fingers are placed on the mandible
• Mandible is pulled up into the mask to perform a
jaw-thrust and chin-lift maneuver
• The assistance squeeze the reservoir bag

24. A: Holding the mask with two hands. Esmarch-Heiberg maneuver,
involves dorsiflexion at the atlanto-occipital joint and
protrusion of the mandible anteriorly by exerting a forward
thrust on the rami.
B: The anesthesiologist's chin on the mask elbow can help to
create a better seal between the mask and the patient's face.

25. Mask Straps
• A mask strap is used to hold the mask firmly on the face.
• Care needs to be paid when using a mask strap because
obstruction is more likely to go unrecognized than when
the mask is being held by the anesthesia provider's hand.
• A typical mask strap consists of thin strips arranged in a
circle with two or four projections.
• The head rests in the circle, and the straps attach around
the mask connector. The straps at the jaw may tend to pull
the jaw posteriorly.
• Crossing the two lower straps under the chin may result in
a better fit and counteract the pull from the upper straps so
that there is less tendency for the mask to creep up above
the bridge of the nose.

26.  Straps should be no tighter than necessary to achieve a seal in order
to avoid pressure damage from the mask or the straps.
 They should be released periodically and the mask moved slightly.
 Gauze sponges placed between the straps and the skin will help to
protect the face from excessive pressure.
 Another risk of using a mask strap is that it will take longer to
remove the mask if vomiting or regurgitation occurs.

27. Complications
Skin Problems:
• Dermatitis in allergic pts. If rubber is a component of a
face mask, a serious reaction can occur in the patient with
latex allergy.
• Chemical or gas used for sterilization of reusable masks
can cause allergy.
• Pressure necrosis under the face mask .
Nerve Injury:
• Pressure injury to underlying nerves.
• Forward jaw displacement may result in stretching nerve
injury.
User Fatigue: cramped hands and tired muscles and limits
the user's ability to perform other tasks specially in obese
and patient with larger head

28. Eye Injury: corneal abrasion may be caused by a face
mask inadvertently placed on an open eye
• Pressure on the medial angles of the eyes and
supraorbital margins may result in eyelid edema,
chemosis of the conjunctiva, pressure on the
supraorbital or supratrochlear nerve, corneal injury,
and temporary blindness from central retinal artery
occlusion
Gastric Inflation of stomach ( So Inspiratory pressure
should be kept<20 cm H2O)
Foreign Body Aspiration: occur in case of endoscopic
mask
Postoperative Jaw Pain.

29. OROPHARYNGEAL AND
NASOPHARYNGEAL AIRWAY

30. Pharyngeal Airway
• Most common cause of
airway obstruction is due
to fall back of tongue and
epiglottis into the
posterior pharynx due to
relaxed muscles in the
floor of the mouth and
pharynx supporting the
tongue.

31. AIM OF OROPHARYNGEAL AIRWAY
• To lift the tongue and epiglottis away from the
posterior pharyngeal wall and
• prevent them from obstructing the space above
the larynx .

32. OROPHARYNGEAL AIRWAY
• May be made of elastomeric
material, metal, or plastic
• Curved tube used to provide
free passage of air between
the mouth and pharynx of
an unconscious person
• FLANGE at the buccal end to
prevent Oro-Pharyngeal Axis
from moving deeper into
the mouth and a means to
fix the airway in place

33. • BITE PORTION is short firm and straight portion that fits
between the teeth or gums, prevents patient biting and
obstructing the air channel
• CURVED PORTION corresponds to the curvature of the
tongue and oropharynx for their effective separation,
• The pharyngeal end rests between the posterior wall of
the pharynx and the base of the tongue, by exerting
pressure along the base of the tongue, also pulls the
epiglottis forward.

34. USES
• Helps to maintain an open airway in unconscious
patient.
• Prevents a patient from biting and occluding an oral
endotracheal tube.
• Protect the tongue from biting.
• Facilitate oropharyngeal suctioning.
• Provides a pathway for inserting devices into the
esophagus or pharynx .

35. SPECIFIC AIRWAYS
WATERS AIRWAY
• made of metal
• an oval flange, a straight bite
block section, an
anatomically curved
pharyngeal section
• holes at the side near the
distal end
• Discarded due to its
propensity to damage teeth
and soft tissue and inability
to see any foreign material
lodged within it.

36. GUEDEL’s AIRWAY
• single use
• integrated bite block, colour
coded
• smooth bevelled tip for easy
insertion and minimising the
risk of trauma
• available in 9 size depnding on
distance between the center
of the incisors and the angle
of the jaw.

37. • #000, 00, 0, 1- 6 with length of 30 to 110 mm.
• size #000 and 00 are for premature and full term new
born babies respectively. Size 0, 1 and 2 are for
children and rest are for adults

38. BERMAN
• has a center support and
channels along each side that
allow a suction catheter or
ETT to slide into the
pharyngeal space.
WILLIAMS AIRWAY INTUBATOR
• proximal half is cylindrical,
while the distal half is open on
its lingual surface.
• designed for blind orotracheal
intubations

39. PATIL-SYRACUSE ENDOSCOPIC
AIRWAY
• made from aluminum
• designed to aid fiberoptic intubation
• has lateral channels and a central groove on the lingual
surface to allow a fiberscope with a tracheal tube to
pass
• slit at the distal end allows the fiberscope to be
manipulated in the AP direction.

40. OVASSAPIAN FIBEROPTIC INTUBATING
AIRWAY
• Designed to deliver a
fiberscope as close to the
larynx as possible
• at the buccal end are
two vertical sidewalls
and between them is a
pair of guide walls that
curve toward each other.
• accommodate a tracheal
tube up to 9.0mm .

41. BERMAN INTUBATING/PHARYNGEAL
AIRWAY
• Tubular along its entire
length
• Open on one side so
that it can be split and
removed from around a
tracheal tube
• used as an oral airway
or as an aid to
fiberoptic or blind
orotracheal intubation.

42. Technique of Insertion
• Pharyngeal and laryngeal
reflexes should be depressed.
• correct size estimated by
holding the airway next to the
patient's mouth. The tip should
rest cephalad to the angle of the
mandible.
• lubricate the airway
• the jaw is opened with the left
hand
• the airway is inserted with its
concave side facing the upper
lip

43. • When the junction of the bite portion and the curved
section is near the incisors, the airway is rotated 180°
and slipped behind the tongue into the final position.

44. NASOPHARYNGEAL AIRWAY
• Resembles a shortened
tracheal tube with a flange at
the outer end to prevent it
from completely passing into
the nare.
• Flange is movable in some
models.
• When fully inserted, the
pharyngeal end should be
below the base of the tongue
but above the epiglottis

45. USES
• Used during and after pharyngeal surgery
• To apply continuous positive airway pressure (CPAP)
• To facilitate suctioning and as a guide for nasogastric
tube.
• as a guide for a fiberscope and to maintain ventilation
during fiberoptic endoscopy
• To dilate the nasal passages in preparation for
nasotracheal intubation
• Used in dental surgery
• can be fitted with a tracheal tube connector and
used with an anesthesia breathing system

46. •
• Better tolerated than an oral airway
• Preferable if the patient's teeth are loose or there is
trauma or pathology of the oral cavity
• used when the mouth cannot be opened for
introducing an oral airway.
Advantages over Oropharyngeal Airway

47. LINDER NASOPHARYNGEAL AIRWAY
• made of plastic with a large
flange
• distal end lacks bevel
• supplied with an introducer,
which has a balloon on its
tip that can be inflated and
deflated by attaching a
syringe to the one -way
valve at the other end .

48. CUFFED NASOPHARYNGEAL AIRWAY
• similar to a short cuffed tracheal tube
• inserted through the nose into the pharynx, the cuff is
inflated, and then is pulled back until resistance is felt.
BINASAL AIRWAY
• consists of two nasal airways joined together by an
adaptor for attachment to the breathing system
• used to administer anaesthesia or to provide CPAP to
babies

49. Insertion
• Diameter of the nasal airway should be the same
as needed for a tracheal tube (0.5 to 1 mm smaller
than for an oral tracheal tube)
• Lubricated thoroughly along its entire length.
• Inspect each nostril for size, patency, and the
presence of polyps
• Use vasoconstrictor drops before insertion

50. Correct method :NPA is inserted
perpendicularly, in line with the
nasal passage
Incorrect method : The airway is
being pushed toward the
roof of the nose and into the
turbinates
Airway is held with the bevel against the septum and gently
advanced posteriorly while being rotated back and forth.
If resistance is encountered during insertion, the other nostril or a
smaller size airway should be used.

51. Contraindications Of Nasopharyngeal
Airway
• Anticoagulation;
• Basilar skull fracture;
• Pathology(polyp), or deformity of the nose or
nasopharynx;
• Bleeding disorder or a history of nose bleeds
requiring medical treatment.
There is no evidence that nasal airways cause
significant bacteremia

52. COMPLICATIONS
Airway Obstruction
• The tip of an airway can press the epiglottis or tongue against
the posterior pharyngeal wall and cover the laryngeal aperture.
• With a nasopharyngeal airway, neck movement in rotation or
anteroposteriorly may result in the lumen becoming obstructed.
The use of a fenestrated airway may overcome this problem.
• The nasopharyngeal airway lumen may be compressed inside
the nose tip can press the epiglottis or tongue against the
posterior pharyngeal wall
Trauma
Injury to the nose and posterior pharynx may cause epistaxis .
Central Nervous System trauma can occur if the patient has basilar
skull fracture and if the nasal airway enters the anterior cranial
fossa.

53. Tissue Edema
Ulceration and Necrosis of the nose or tongue can
occur.
Dental Damage
Laryngospasm and Coughing
Retention, Aspiration, or Swallowing
Allergic Reaction to Latex
Gastric Distention

54. Thank You…