|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 3 | Page : 161-162
Baska Mask® as a definitive airway during balloon dilatation of circumferential soft-tissue tracheal lesion
G Satheesh, Atif Khan, Mridul Dhar, Bhavna Gupta
Department of Anesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
|Date of Submission||12-Nov-2020|
|Date of Acceptance||16-Nov-2020|
|Date of Web Publication||25-Dec-2020|
Dr. Bhavna Gupta
Department of Anesthesiology, Level 6, Academic Block, All India Institute of Medical Sciences, Rishikesh, Uttrakhand
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Satheesh G, Khan A, Dhar M, Gupta B. Baska Mask® as a definitive airway during balloon dilatation of circumferential soft-tissue tracheal lesion. Airway 2020;3:161-2
|How to cite this URL:|
Satheesh G, Khan A, Dhar M, Gupta B. Baska Mask® as a definitive airway during balloon dilatation of circumferential soft-tissue tracheal lesion. Airway [serial online] 2020 [cited 2021 Apr 16];3:161-2. Available from: https://www.arwy.org/text.asp?2020/3/3/161/304855
Baska mask® (Logikal Health Products Pty Ltd., Morisset, New South Wales 2264, Australia) is a third-generation supraglottic airway device (SAD) whose clinical utility in tracheal dilatational surgeries is not reported in literature. A 59-year-old male with chronic obstructive pulmonary disease (COPD) was diagnosed to have adenoid cystic carcinoma of the trachea for which he had undergone tracheal stenting 2 years prior. He presented with the complaints of productive cough for 3 months associated with breathlessness (modified Medical Research Council Grade III). He was a chronic beedi smoker over the previous 20 years and had no other comorbidities. Contrast-enhanced computed tomography of the thorax showed an ill-defined, moderately enhancing soft-tissue attenuation encasing the metallic stent in the trachea and a circumferential, moderately enhancing soft tissue at the level of D4 vertebra.
On examination, air entry was reduced bilaterally with inspiratory and expiratory rhonchi in both basal lung fields. His mouth opening was three finger breadths with a modified Mallampati Class II and normal neck movements. He was nebulised with budecort and salbutamol before being wheeled into the operation theatre. General anaesthesia was induced with fentanyl and propofol with no muscle relaxant. Baska mask® size 4 was inserted and a suction catheter was inserted via the gastric drain port. Anaesthesia was maintained with sevoflurane in 50% oxygen in air. An endoscopy-compatible catheter mount was placed between the Baska mask and the circuit. A flexible bronchoscope was passed through the catheter mount, the site of the circumferential growth was identified and a circumferential incision was placed towards the luminal side [Figure 1]. Active bleed at the local site was controlled using around 5–7 mL of 1:100,000 adrenaline at the local site and suctioned out subsequently. The patient was given 100% oxygen for 3 min and the ventilator circuit was disconnected from the catheter mount. A tracheal balloon was introduced [Figure 1] and dilated twice at the site of the lesion for 60-s duration with 5-min intervals in between, during which the circuit was connected back to the catheter mount. Airway pressures during the procedure did not exceed 22 cm H2O. At the end of the procedure, the circuit was connected again and the patient was ventilated with 100% oxygen for 2 min. Stable haemodynamics was maintained. Inhalational agents were discontinued, and the Baska mask was removed after the patient regained consciousness and started obeying commands. The patient was shifted to the postoperative ward. A chest X-ray taken 6 h later was normal.
|Figure 1: Circumferential tracheal lesion with subsequent circumferential incision and balloon dilatation|
Click here to view
Excision biopsy and therapeutic excision of lesions in the trachea have been successfully performed by using conventional laryngeal mask airway and newer-generation SADs. Securing a definitive airway in tracheal surgeries and maintaining airway patency during such situations are challenging for the anaesthesiologist.
Baska mask, a third-generation SAD, can be selected over other SADs and definitive airways in tracheal dilatational surgeries with minimal intraoperative complications. First, there is no risk of cuff puncture by surgical instruments during the procedure. Second, airway pressures during the procedure are less affected when compared to the use of other SADs due to self-sealing variable-pressure membranous cuff. Third, leak of gases and gastric insufflation during positive pressure ventilation is less likely due to high seal pressure. Fourth, as the use of muscle relaxants in such cases may worsen the patency of airway, presence of an integrated bite block favours the usage of bronchoscope through the Baska mask during general anaesthesia without paralysis. Fifth, patients with COPD are at an increased risk of? pulmonary complications which can be minimised with the use of Baska mask as opposed to endotracheal intubation. The Baska mask is an appropriate alternative to tracheal intubation because of its advantages such as stable haemodynamics and decreased airway morbidity.
From our experience, we conclude that the Baska mask can be used as a safe and effective definitive airway during tracheal luminal surgeries with flexible bronchoscopy. Such a technique could also reduce the incidence of intraoperative complications during minimally invasive intratracheal surgeries.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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