The mask seal on a man with a full beard may be poor, resulting in difficult ventilation. A number of maneuvers can be attempted to allow ventilation. Some of the techniques can also be used for a patient who is edentulous and difficult to ventilate.


If the problem is noted in advance of surgery, then the man can be asked to shave off the beard. Since many men are attached to their facial hair, this may not be an option.


The beard can be matted down with petroleum jelly, but this can make the mask and skin slippery.


Crooke reports a clever idea handed down from his father, which is to evert the lower lip and to place the caudal rim of the mask on the exposed buccal membrane. This provides a seal that is sufficient to allow mask ventilation.


If a laryngeal mask airway (LMA) is available, this can be inserted.


If a laryngeal mask airway is not available then a "poor man's LMA" can be used during induction, which consists of:

(1) inserting an endotracheal tube into the oropharynx with the tip above the epiglottis. In Figure 1 (page 484) the cuff is placed between the tongue and posterior pharyngeal wall and is then inflated.

(2) having a colleague compress the lips and nares while the patient is ventilated


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