The Articulated Oral Airway as an Aid to Mask Ventilation

Difficult mask ventilation (MV) is common in the obese population and can result in patient morbidity and mortality. The Articulating Oral Airway (AOA) is a novel oral airway which actively displaces the tongue, allowing for a greater cross-sectional area for MV. The investigators hypothesize that, while using the same ventilatory pressure in neuromuscularly blocked patients with predictors for difficult mask ventilation, MV with an AOA will not result in smaller expired tidal volumes than MV with a similarly sized Guedel oral airway (GDA). In other words, the AOA will be non-inferior to the GDA in terms of expired tidal volumes.

Inclusion criteria

• Individuals demonstrating 2 or greater predictors of difficult mask ventilation (as listed below) who are scheduled for elective surgery with general anesthesia and asleep mask ventilation/orotracheal intubation utilizing long-acting neuromuscular blockade.
• Predictors of difficult mask ventilation i) Age > 55 years ii) BMI > 30kg/m2 iii) Beard iv) Lack of teeth v) History of snoring

Exclusion criteria

• Documented history of impossible mask ventilation
• Planned omission of mask ventilation ('rapid-sequence induction,' etc.)
• Planned omission of long-acting paralytics
• Need for awake airway management
• Need for emergent airway protection
• Presence of oropharyngeal anatomic abnormalities
• Distance from the maxillary incisors to the angle of the mandible <11cm
• <18 years of age
• Known pregnant state
• Current incarceration
• Refusal to be involved in the study