A simple combined nasal mask-face tent provided nasal cpap oxygenation and reduced aerosol/ droplet spread in an obese patient with jarcho-levin syndrome and a difficult airway during colonoscopy under sedation

Background: Patients under sedation often receive nasal cannula O2. Airway obstruction may result in severe desaturation, especially in obese patients with obstructive sleep apnoea (OSA). Paediatric facemasks were shown to provide nasal CPAP ventilation and improve oxygenation in sedated OSA patients.1 Amid COVID pandemic, a nasal mask-face tent provided continuous oxygenation and reduced aerosol/ droplet spread during RSI and intubation/extubation in COVID-19 positive patient.2 It avoided severe desaturation and reduced aerosol/droplet spread during difficult intubation/extubation in a morbidly obese patient.3 We used it in a patient with Jarcho-Levin Syndrome (JLS) undergoing colonoscopy. Case Report: A 21 year-old JLS male, BMI 33.2 kg/m2, with OSA, asthma, respiratory insufficency, restrictive lung disease and diverticolitis presented for colonoscopy. He had Class IV airway and shortened thorax, severe scoliosis/kyphosis and short neck without extension/flexion. An infant facemask was secured over his nose and connected to anaesthesia machine/circuit delivering 7-10 cm H2O CPAP (4L O2/min) (Fig.1). SpO2 improved from 97% to 100%. Sedation was titrated with 100 mg lidocine and 3x50 mg propofol and maintained on propofol infusion (150-400 mcg/kg/min). His mouth was covered with clear plastic sheet and a suction catheter was secured to reduce aerosol/ droplet spread. He maintained spontaneous ventilation without any airway manipulation and 97- 100% SpO2 throughout (Fig.2). He required high doses of propofol (total 650 mg) for the 30-min procedure. He recovered quickly without any complication. Discussion: This simple combined nasal mask-face tent maintained spontaneous CPAP ventilation/ oxygenation in an obese patient with Jarcho-Levin Syndrome, respiratory insufficiency during colonoscopy. It reduced aerosol/droplet spread during the procedure. Amid COVID-19 pandemic, it may improve patient safety and provide additional provider protection. (Figure Presented).