Simple nasal mask-face tent provided CPAP oxygenation and lowered aerosol/droplet spread in an obese OSA patient during EPS/VT Ablation

ABSTRACT

Background: A paediatric facemask was used to maintain spontaneous nasal ventilation/oxygenatoion in deeply sedated obese OSA patients.1-2 Amid COVID-19 pandemic, a combined nasal mask-face tent provided pre/apneic nasal oxygenation and reduced aerosol/droplet spread during RSI, intubation and extubation in a COVID-19 positive patient.3 It avoided severe desaturation and reduced aerosol/ droplet spread during difficult intubation/extubation in a morbidly obese patient.4 We used it in an obese OSA patient during EPS/VT ablation. Case Report A 79-year-old COVID-negative male, BMI 30.7 kg/m2, with HTN, OSA, CAD, s/p PCIx3 stents, dilated cardiomyopathy, AICD/pacemaker, presented for EPS/VT ablation under sedation. A toddler facemask was secured over his large nose with elastic head-straps and connected to the anaesthesia circuit/machine delivering 6-8 cm H2O CPAP with 4L/min O2. His mouth was covered with a clear plastic sheet (face-tent) (Fig.1). Moderate sedation was achieved with midazolam and remifentanil infusion. SpO2 improved from 93% to 100%. During ablation, GA was requested due to his breathing interfering with ablation. He was induced and intubated with propofol/etomidate/rocuronium. Video-laryngoscopy-assisted intubation was performed under the face-tent while the nasal mask delivering pressure-control ventilation/oxygenation (Fig.2). His SpO2 was maintained at 100% throughout. He was extubated smoothly with nasal mask-face tent to maintain spontaneous ventilation/ oxygenation and minimize aerosol/droplet spread (Fig.1). Discussion: This simple nasal mask-face tent maintained continuous CPAP ventilation in an obese OSA patient during EPS. It provided pressure-control ventilation/oxygenation during GA induction and intubation. It also reduced aerosol/droplet spread during the procedure. Amid COVID-19 pandemic, it should be used as a universal precaution to provide additional provider protection. (Figure Presented).