Mask Ventilation Failure During Induction of General Anesthesia in an Infant With Osteogenesis Imperfecta Type II.

Osteogenesis imperfecta (OI) is a congenital disease characterized by fractures and progressive bone deformities due to systemic bone fragility. A 12-month-old male infant diagnosed with OI type II, the most severe type, was scheduled for a tracheostomy. The patient presented with thoracic hypoplasia, which was treated with a high-flow nasal cannula, and a large skull owing to hydrocephalus with the head fixed in a left anteversion position. We encountered difficulties in mask ventilation during the rapid induction of general anesthesia. Oxygen saturation dropped temporarily, but the patient's condition stabilized after intubation. The tracheostomy was performed as scheduled and was completed without any complications. Difficulty in mask ventilation with low thoracic compliance due to thoracic hypoplasia, combined with air-induced gastric dilatation and upper airway obstruction, may have contributed to the ventilation failure. Most OI type II patients have large skulls owing to hydrocephalus and thoracic hypoplasia. Since no iatrogenic fractures related to airway management were observed in this or past cases, bone fragility may not be concerning to the extent that airway management becomes compromised. If patients present with poor oxygenation due to thoracic hypoplasia, the possibility of difficulty with mask ventilation due to low compliance should be considered in airway management.