How can we improve mask ventilation in patients with obstructive sleep apnea during anesthesia induction?

Recent evidence suggests the possible development of difficult mask ventilation in patients with obstructive sleep apnea. Based on our current understanding of the pathophysiology of pharyngeal airway obstruction in obstructive sleep apnea patients, we conclude that anesthesiologists can decrease respiratory complications during anesthesia induction by conducting careful pre-induction preparations, including body and head positioning and sufficient preoxygenation, and by using the two-hand mask ventilation technique with effective airway maneuvers and appropriate ventilator settings while continuously assessing ventilation status with capnography.