To the Editor:—

Dr. Johnson et al. . 1describe a useful method to reduce gas leaks from the face mask in bearded patients and thus enable adequate oral positive-pressure ventilation en route  to tracheal intubation.

In this type of situation, one can also opt to avoid the oral route entirely and attempt nasal positive-pressure ventilation instead, using a smaller, clear, padded mask (i.e.,  the size of a toddler, an infant, or even a neonate mask). Using this technique, the mouth is kept firmly closed and the head is extended. The mask covers the nostrils but does not extend beyond the upper lip. By reducing the surface over which ventilation occurs, the potential for leakage of anesthetic gas may be reduced. Furthermore, the airway often is easier to support if the mouth does not have to be kept open.

Nasal positive-pressure ventilation can be an effective mode of ventilation in edentulous patients when conventional mask ventilation fails because of excessive gas leakage from the mask. It may also be a useful mode of ventilation in the bearded patient. An occasional problem is leakage of gas from within the mouth, but this leakage is usually not serious enough to compromise ventilation.

Johnson JO, Bradway JA, Blood T: A hairy situation (letter). A NESTHESIOLOGY 1999; 91:595