Background: Patients with OSA can provide difficulties with oxygenation and ventilation after general anaesthesia (GA) induction. A nasal TSE-PAP mask assembly has been shown to maintain oxygenation by delivering nasal CPAP, BiPAP or PPV in adult patients with OSA during sedation, GA or awake/asleep endotracheal intubation (ETI)(1-5). However, it has rarely been used in paediatric patients(6-7). We used it in a paediatric patient with OSA for GA induction for laparoscopic appendectomy. Case Report: A 8-year-old, 133 cm, 42 kg, male with OSA s/p tonsillectomy and adenoidectomy (T&A), presented with acute appendicitis for laparoscopic appendectomy on a Saturday. His father described some difficulty breathing at night in the patient consistent with OSA despite past T&A. His father gave his consent to use a nasal mask and for taking photographs for case-report. The patient received 2 mg midazolam and was transported to the OR in a calm manner. An infant mask (#2) with fully inflated air cushion was secured over his nose with head-straps. It was connected to a breathing circuit/machine with 4 L O2/min and 1L /min air. APL valve was adjusted to deliver 5 cm H2O CPAP (Fig. 1). He then received 40 mg lignocaine, 50 mg propofol and 20 mg rocuronium. His mouth was closed and a tight nasal mask was obtained with one hand. Nasal ventilation was easily accomplished. With the nasal mask delivering apnoeic oxygenation, a #2 blade video-laryngoscope was inserted which revealed a class I airway. A 6.0 ETT was inserted to 16 cm and secured (Fig. 2-3). His SpO2 remained 100% throughout. He tolerated the procedure well. Immediately post-extubation, he received the same nasal mask with 5 cm H2O CPAP. A bag-valve device was used to deliver nasal CPAP during a long transport from the 1st floor OR to the 7th floor paediatric PACU without incident. Discussion: This simple nasal TSE-PAP mask assembly was used to provide continuous active oxygenation in a paediatric patient with OSA during GA induction. Besides CPAP pre-oxygenation, it provided means to deliver assisted nasal ventilation, apnoeic oxygenation during VL ETI and CPAP during long but safe transport to paediatric PACU. It may improve patient safety at a low cost. Ref: 1. www.TSEMask.com; 2. SAMBA 28th AM, 2013; 3. SASM 3rd AM, 2013; 4. ASA AM, 2013; 5. SAM AM, 2014; 6. ASA AM, 2015; 7. SPA-AAP, 2016 Learning Points: How to prepare a nasal mask assembly and to provide nasal CPAP in paediatric patients and assisted nasal ventilation in patients with OSA.
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