PROF HIROFUMI ARISAKA (Orcid ID : 0000-0002-1452-5057)

Article type : Letter

Accepted Article
Handling Section Editor:Dr David Polaner

Title Page

Letters to the Editors

Modification of the use of mask for inhalation induction in uncooperative patients

Article category: Correspondence

Takeo Sugita D.D.S., Ph.D., Nobuo Umezawa D.D.S., Ph.D., Akiko Matumoto D.D.S., Ph.D., Tomoko

Takano D.D.S., Ph.D., and Hirofumi Arisaka M.D., D.D.S., Ph.D.

Division of Anesthesiology, Department of Highly Advanced Stomatology, Kanagawa Dental University

Graduate School, Yokohama,Japan

Corresponding Author: Prof Hirofumi Arisaka

Address: 3-31-6 Tsuruya-cho, Kanagawa-ku Yokohama, 221-0835, Japan

E-mail: arisaka@kdu.ac.jp

Tel: +81-45-313-0007

Fax: +81-45-313-0027

This article has been accepted for publication and undergone full peer review but has not
been through the copyediting, typesetting, pagination and proofreading process, which may
lead to differences between this version and the Version of Record. Please cite this article as
doi: 10.1111/pan.13628
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 Keywords: inhalation induction, mask, uncooperative patients
Accepted Article
Body Text

In our institution, we often encounter handicapped and pediatric patients who undergo inhalation

induction with sevoflurane because securing an intravenous line before anesthesia induction is difficult.

Inhalation induction (nitrous oxide: 66%, sevoflurane: 8%) takes 60 seconds to acquire loss of eyelash

1 2
reflex. Single breath induction, which is faster, is not always tolerated.

Handicapped and pediatric patients may be unable to follow breathing instruction, dislike the

smell of sevoflurane, push the mask away, or breath-hold. They may even become combative,

requiring restraint and prolongation of induction time. We describe an inhalation induction method

using a mask capable of reducing these problems.

For the mask, a one-size smaller mask than that for the standard method is used. The mask is

used upside down, and the vinyl part containing air, which is originally present at the mandibular end of

the mask, is tightly contacted to the nasal cavities for sealing. Since the curve of the mandibular end of

the mask is moderate, the nasal cavities are completely sealed, by which smell can be prevented. At

this point, the original maxillary end of the mask is located on the mandibular mental region. Air is likely

to leak when the normal-size mask is used, but protrusion of the maxillary end of the mask from the

mental region can be prevented by using the one-size smaller mask, securing sealing of the mask

(Figure 1A ). After confirming sleep onset based on loss of eyelash reflex, the mask procedure was

changed to the standard method with a normal-size mask (Figure 1B).

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 By slightly modifying the standard method of mask use, anesthesia could be induced smoothly in
Accepted Article
handicapped and pediatric patients with difficulty in communication and strong resistance to inhalation

induction, and the time taken for anesthesia induction was markedly shortened. Since the problem with

smell of inhalation induction can be solved, this method may also be useful for inhalation induction in

adults.

ETHICALAPPROVAL

Parental consent was received.

CONFLICT OF INTEREST

The authors report no conflict of interest.

References

1. Hall JE, Oldham TA, Stewart JI, Harmer M. Comparison between halothane and sevoflurane for

adult vital capacity induction. Br J Anaesth 1997; 79(3):285-288.

2. Djaiani GN, Hall J, Pugh S, Peaston RT. Vital capacity inhalation induction with sevoflurane: an

alternative to standard intravenous induction for patients undergoing cardiac surgery. J

Cardiothorac Vasc Anesth 2001; 15(2):169-174.

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Accepted Article
Figure legends

FIGURE 1

One-size smaller mask is used upside down. The nasal cavities are completely sealed, by which smell

can be prevented and air leak can be prevented on mandibular mental region(A). Standard mask

method(B)

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Accepted Article
(A)

(B)

Fig 1

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