Journal of Anesthesia

, Volume 19, Issue 1, pp 7–11

The incidence and risk factors of difficult mask ventilation

  • Tulay Sahin Yildiz
  • Mine Solak
  • Kamil Toker

DOI: 10.1007/s00540-004-0275-z

Cite this article as:
Yildiz, T., Solak, M. & Toker, K. J Anesth (2005) 19: 7. doi:10.1007/s00540-004-0275-z



The ability to ventilate and oxygenate a patient using a bag-mask breathing system may be lifesaving in the case of failure of the initial intubation attempt. In this study, we aimed to determine the incidence of difficult mask ventilation (DMV) and to find preoperative risk factors for this procedure.


Based on methods used for overcoming some difficulties with bag-mask ventilation (MV), classification has been made into four categories: easy MV, awkward MV, difficult MV, and impossible MV. A univariate analysis was performed to identify potential risk factors predicting DMV, followed by a stepwise forward binary logistic regression, and the odds ratio and 95% confidence interval were calculated.


A total of 576 patients were studied. Incidence of easy MV, awkward MV, and difficult MV were found to be 75.5% (n = 435), 16.7% (n = 96), and 7.8% (n = 45), respectively. Height, weight, age, male gender, increased Mallampati class, history of snoring, lack of teeth, and beard were found to be DMV risk factors (P < 0.05). Using a multivariate analysis, Mallampati class 4, male, history of snoring, age, and weight were found to be significantly associated with DMV. Although the incidence of DMV in general was 7.8% (n = 45), the incidence of DMV among patients with difficult intubation (n = 123) was found to be 15.5% (n = 19).


Mallampati class 4, male patients, history of snoring, increasing age, and increasing weight were found to be risk factors for DMV in our study.

Key words

AirwayDifficult mask ventilationIntubation

Copyright information

© JSA 2005

Authors and Affiliations

  • Tulay Sahin Yildiz
    • 1
  • Mine Solak
    • 1
  • Kamil Toker
    • 1
  1. 1.Department of Anesthesiology, School of MedicineUniversity of KocaeliKocaeliTurkey
  2. 2.KocaeliTurkey