The skillful use of a face mask is challenging and, despite the many advances in airway management, remains a mainstay in the delivery of anesthesia and resuscitation. 

Appropriate positioning of the patient

is paramount to successful mask ventilation.

With the patient in the supine position,

the head and neck are placed

in the sniffing position.

Holding the anesthesia mask on the face:

 

the mask should fit snugly around the bridge of the nose, cheeks, and mouth,

 clear plastic masks allow for observation of the lips (for color) and mouth (for secretions or vomitus),

the thumb and the first finger grip the mask in such

a fashion that the anesthesia circuit (or ambu bag) connection abuts the web between these digits,

 

this allows the palm of the hand to apply pressure

to the left side of the mask, while the tips of these three digits apply pressure over the right,

 

the third finger helps to secure under the mentum, while the forth finger is under the angle of the mandible or along the lower mandibular ridge.

 

When mask ventilation is difficult owing to upper airway obstruction, a second operator may be required.

2 or 3 hands can be used in a jaw thrust maneuver

nasal airway

oral airway

A variety of oral and nasal airways are available.

The goal of these devices is to hold the base of the tongue forward to create an air passage.

 

nasal (A) and oral (B) airways

 

nasal airways