Which of the following is NOT among the factors that predict difficulty with bag-valve mask ventilation (BVM)?

• A. Facial hair
• B. Obesity
• C. Snoring
• D. Mallampati score

Answer: (D)

In bag-valve mask ventilation, what matters most is achieving a good seal and keeping the airway open. Facial hair can prevent a tight seal, obesity increases tissue mass and can impede airway patency and chest excursion, and snoring suggests obstructive sleep apnea with a tendency for airway collapse, all of which raise the chance of a difficult mask seal or ventilation. Mallampati score, however, is a grading system used to predict how difficult intubation will be by assessing the visibility of oropharyngeal structures during direct laryngoscopy, not the ease of achieving a mask seal or ventilating with a bag-valve mask. Therefore, Mallampati score is not a reliable predictor of BVM difficulty.