The ASA Task Force on Management of the Difficult Airway defined difficult bag-mask-ventilation as: "it is not possible for the anesthesia practitioner to provide adequate face mask ventilation due to one or more of the following problems: inadequate mask seal, excessive gas leak, or excessive resistance to the ingress or egress of gas."14 The incidence of difficult bag-mask-ventilation is in the range of 5%15 while failed bag-mask-ventilation is in the range of 0.01% to 0.08%.13
Langeron identified five risk factors for difficult mask ventilation: beard, obese (BMI >26), age greater than 55, lack of teeth, and history of snoring (MOANS, see Section 1.6.1).15 Our patient has four of the five risk factors and is at a moderately increased risk of difficult mask ventilation. More recently, Kheterpal et al identified independent predictors for difficult or impossible mask ventilation: obese (BMI >30), beard, Mallampati III or IV, age = 57, limited jaw protrusion, snoring, neck radiation, male gender, and obstructive sleep apnea.16,17