Hardware Causing Hard Times: Use of the SuperNO2 VA™ Nasal PAP Device to Address Airway Challenges Caused by Eroding Mandibular Hardware.
Maintenance of the airway and adequate ventilation prior to endotracheal intubation is
essential for the anesthetized patient. However, this may be compromised in patients with obesity
or obstructive sleep apnea due to partial or complete pharyngeal obstruction.
In patients with facial trauma, craniomaxillofacial anomalies, or presence of external hardware, it may not
be possible to achieve an adequate mask seal or perform bagmask-ventilation with a conventional facemask. For these patients and others with confirmed or suspected difficult airways, management
alternatives including nasal ventilation may be more appropriate.
The SuperNO2 VA™ device is a nasal mask developed to provide nasal positive
pressure ventilation in spontaneously breathing and apneic patients during anesthesia and endotracheal intubation. In a pilot study designed to evaluate the clinical performance of the SuperNO2 VA™ in paralyzed patients under general anesthesia, nasal mask ventilation was successfully implemented in 97% of patients with nasal oxygenation continued during laryngoscopy and orotracheal intubation, with no adverse events.
Much the same way nasal continuous positive airway pressure complements full facemask CPAP, nasal ventilation in apneic patients provides an alternative route to conventional techniques, improving the airway provider’s armamentarium. Additionally, mask seal is simpler to achieve with a nasal mask, using a smaller surface area and simply applying pressure to the mask into the face, whereas downward pressure of a full facemask may displace the mandible and soft tissues posterior into the upper airway.
Res Pract Anesthesiol Open J. 2019; 4(1): 7-10. doi: 10.17140/RPAOJ-4-123
