Clinical Tips & Tricks In Anesthesia

Getting a Good Mask Fit
on Bearded Patients

Problem:

How do you get a good mask seal on a patient with a lot of facial hair? In the past, some have tried smoothing the beard with Surgi-Lube, but it's slippery and leaves a mess, and doesn't really provide a good seal.

Solution #1: Try this trick I copied from a visiting nurse anesthetist:
Take an extra-large Tegaderm and fold it in half. With a scissors, cut a wedge from the center.
When you unfold it, you have a diamond shape hole in the center.
Ask the patient to open his mouth and breathe through the mouth.

Carefully place the tegaderm over the patient's face. Take special care to seal the edge of the hole to the (hairless) lips of the patient.

Smooth the dressing over the rest of the beard.
Now when you place the mask on the face, the seal is between the mask and the tegaderm, and no air escapes because of the seal around the lips.
Solution #2: (Maybe even easier!)

1. Preoxygenate the patient with a reasonably snug mask and coached voluntary spontaneous ventilation.
2. Induce the patient with a generous dose of propofol. Don't even try to ventilate by mask.
3. Place a properly sized LMA.
4. Now manually ventilate the patient via the LMA, while you administer muscle relaxant.
5. After an appropriate interval, remove the LMA, suction and intubate the patient.

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