Related Experiment Video
Updated: Jun 11, 2025
Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA
Published on: July 14, 2023
Mask Ventilation Failure During Induction of General Anesthesia in an Infant With Osteogenesis Imperfecta Type II
Tatsuya Abe1, Yutaka Seino1, Hidekazu Imai1
1Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata, JPN.
Insights
Osteogenesis imperfecta (OI) type II presents significant airway management challenges, particularly mask ventilation, due to thoracic hypoplasia. Careful consideration of low thoracic compliance is crucial for successful anesthesia in these fragile infants.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Genetics
Background:
- Osteogenesis imperfecta (OI) is a genetic disorder causing extreme bone fragility and fractures.
- OI type II is the most severe form, often associated with significant congenital anomalies.
- Infants with OI type II frequently exhibit thoracic hypoplasia and hydrocephalus, impacting respiratory and neurological function.
Observation:
- A 12-month-old male infant with OI type II required a tracheostomy.
- The patient displayed thoracic hypoplasia, hydrocephalus with a fixed head position, and experienced difficulties during mask ventilation induction.
- Temporary oxygen desaturation occurred but resolved after successful intubation, with the tracheostomy completed without complications.
Findings:
- Mask ventilation failure in this OI type II case was likely multifactorial, including thoracic hypoplasia leading to low thoracic compliance, gastric distension, and potential upper airway obstruction.
- Despite severe bone fragility in OI type II, airway management itself did not appear to cause iatrogenic fractures.
- The study highlights that bone fragility may not be the primary limitation for airway management.
Implications:
- Anesthesiologists should anticipate and prepare for potential mask ventilation difficulties in OI type II patients, especially those with thoracic hypoplasia.
- Low thoracic compliance is a critical factor to consider during airway management planning for OI type II.
- Early recognition and management of respiratory compromise are vital for improving outcomes in infants with severe Osteogenesis Imperfecta.
Abstract:
Osteogenesis imperfecta (OI) is a congenital disease characterized by fractures and progressive bone deformities due to systemic bone fragility. A 12-month-old male infant diagnosed with OI type II, the most severe type, was scheduled for a tracheostomy. The patient presented with thoracic hypoplasia, which was treated with a high-flow nasal cannula, and a large skull owing to hydrocephalus with the head fixed in a left anteversion position. We encountered difficulties in mask ventilation during the rapid induction of general anesthesia. Oxygen saturation dropped temporarily, but the patient's condition stabilized after intubation. The tracheostomy was performed as scheduled and was completed without any complications. Difficulty in mask ventilation with low thoracic compliance due to thoracic hypoplasia, combined with air-induced gastric dilatation and upper airway obstruction, may have contributed to the ventilation failure. Most OI type II patients have large skulls owing to hydrocephalus and thoracic hypoplasia. Since no iatrogenic fractures related to airway management were observed in this or past cases, bone fragility may not be concerning to the extent that airway management becomes compromised. If patients present with poor oxygenation due to thoracic hypoplasia, the possibility of difficulty with mask ventilation due to low compliance should be considered in airway management.
Related Concept Videos
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:30Administering Oxygen by Mask
Administering oxygen by mask is a common nursing intervention that provides supplemental oxygen to patients with respiratory distress or chronic lung conditions. This procedure involves delivering oxygen at a specified rate through a face mask connected to an oxygen source.
Equipment
The equipment necessary for this procedure includes:
01:29Mechanical Ventilation I: Indication and Settings
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...