Mask anesthesia


With mask anesthesia, the insertion of a ventilation tube is dispensed with and the patient is ventilated through the mask, i.e. supplied with oxygen. This form of ventilation can be used for short interventions in which the patient can lie on his back.

The anesthetist must hold the mask with light pressure on the mouth and nose during the entire procedure. In adult mask anesthesia, the anesthetic is given through the vein.
Children are usually allowed to breathe an anesthetic gas through the mask.

Read more on this topic on our main article: anesthesia

Mask anesthesia procedure

After the general preparation for the anesthesia, the ventilation mask is often held a few centimeters above the patient's face. This process is called preoxygenation. Oxygen flows out through the mask and the patient breathes in the oxygen-enriched air. This will help saturate the blood with oxygen as much as possible.
This step is very important for anesthesia with a breathing tube, but it does not harm either with mask anesthesia.

Thereafter, a pain reliever and anesthetic are given through a venous access, whereupon the patient loses consciousness within a very short time. At this point the breathing drive fails and mask ventilation must be started. To do this, the head is placed back to clear the airways. Then the anesthetist performs the Esmarch maneuver. With this handle the lower jaw is pushed forward and the base of the tongue is raised. This further widens the airways.

A Guedel tube is inserted into the mouth so that the tongue does not fall back and interfere with ventilation. This tube looks like a curved tube that leads from the teeth to the throat entrance. Then you put the ventilation mask on your mouth and nose.
With a special handle, the mask is held on the face with light pressure so that no air can escape. The actual ventilation can be carried out manually at set intervals by the ventilator or by means of a balloon.

Read more on the topic: Intubation anesthesia

Advantages of mask anesthesia

The advantage of mask anesthesia is the very low degree of invasiveness (tissue damage). The mask is only held on the face and the Guedel tube, which is inserted to keep the airway open, comes to rest in the mouth area. There is no risk of damaging structures in the throat area, vocal cords or the windpipe, as is the case with conventional ventilation. In addition, teeth, lips or tongue are not damaged by ventilation with the mask.

In addition, the drug to relax the muscles (muscle relaxant) can be dispensed with during mask anesthesia. During regular anesthesia, this medication is very important in order to be able to insert the ventilation tube.

Read more on the topic: general anesthetic

Disadvantages of mask anesthesia

Mask anesthesia is only suitable for short interventions, as the anesthetist or a specially trained anesthetist must hold the mask on at all times. Holding the mask restricts the staff's freedom of movement and action and means that two specialists are needed to maintain such anesthesia.

Holding the mask can also be very strenuous, as it must be ensured at all times that no air escapes from the edges of the mask and that air from the ventilator flows into the lungs.

During mask anesthesia, the esophagus and windpipe are not separated by a ventilation tube. This means that rising gastric juice can get into the windpipe. Therefore, only patients with mask anesthesia who are safely sober can be operated on. Furthermore, only operations with mask anesthesia are possible in which the patient can lie on his back. Positioning on one side of the body or on the stomach is not possible with the mask and is a contraindication for mask anesthesia.

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Risks of mask anesthesia

Although the airways can be kept relatively clear with special handles and a Guedel tube, the ventilation situation is never as good as with the ventilation tube, which comes to rest directly in the windpipe.
If good ventilation with the mask is not possible, the anesthetist will always decide on subsequent intubation, i.e. inserting a larynx mask.

The second major risk is the lack of a protective barrier between the windpipe and esophagus. This barrier is usually formed by the breathing tube. During mask anesthesia, gastric juice may rise and flow through the windpipe into the lungs. If it is exclusively gastric juice, this is unfavorable, but not yet harmful per se, since the gastric juice can be broken down in the lungs. However, if there are still food particles in the gastric juice and these then get into the lungs, this can lead to pneumonia. Therefore, only completely sober patients may receive mask anesthesia.

Find out more about: Risks of anesthesia

Special features of mask anesthesia in children

Even with children, mask anesthesia is only suitable for short interventions and cannot be used for every operation. Children often get the anesthetic drugs as gas through the mask, which is later used for ventilation and not through a venous access.

Read more on the topic: Anesthesia in children

Mask anesthesia at the dentist

Mask anesthesia is a type of general anesthetic. General anesthesia are seldom necessary at the dentist and require that the dental practice has a special operating theater and works with a team of anesthetists.

With some dental diseases, however, the procedure may be performed under general anesthesia. Depending on the standard of the practice or the clinic, the anesthetics are given as gas either through the vein or through the mask. After the patient is asleep, however, a small tube is always inserted into the windpipe. Mask ventilation is not possible during dental interventions.

Find more information at: General anesthesia at the dentist

What are the alternatives to mask anesthesia?

There are two common alternatives to mask anesthesia. On the one hand, ventilation can be carried out in the classic way using a ventilation tube. The gentler method is to insert a larynx mask. The larynx mask seals the area above the larynx with a soft cushion that is inflated.

The ventilation is then carried out like an anesthesia with a ventilation tube, but the advantage is that the vocal cords and the windpipe are not damaged by the ventilation tube. The larynx mask is also only useful for short interventions and, as with mask anesthesia, the patient must be completely sober.

Read more on the topic: Types of anesthesia