Difficult mask ventilation: does it matter?

We discuss the relevance of finding a patient's lungs difficult to ventilate by facemask during the course of anaesthetic induction. In particular, we discuss the issue of whether it is advisable or unnecessary to check the ability to ventilate by facemask before administering a neuromuscular blocking agent. In the light of advances in supraglottic airway technology it has become possible to insert these devices very soon after induction and in a wider variety of patients. Similarly, the development of videolaryngoscopes and rapidly acting drugs such as rocuronium have raised the possibility of earlier, and possibly more successful, tracheal intubation, with the potential result that mask ventilation becomes redundant. However, we conclude by reaffirming its value in airway management strategies.