The mask is gently held over the patient's face with the left hand, leaving the right

hand free for other uses ( Fig - 3). The thumb and the firstfingergrip the mask in such a fashion that the anesthesia circuit (or ambu big) connection abuts the web between these digits.This allows the palm of the hand to apply pressure to the left side of the mask, while the tips of these three digits apply pressure over the right. The third finger helps to secure under the centum, while the fourth finger is under the angle of the mandible or along the lower mandibular ridge. When mask ventilation is difficult owing to upper airway obstruction a second operator may be required so that two or three hands can be used in a jaw thrust maneuver. b) Artificial Airways

Airways when correctly placed, lift the tongue away from the posterior wall and thus help in maintaining a clear passage. Oral airways ,which come in a wide variety of sizes can stimulate the semiconscious patient and provoke coughing, vomiting, and laryngospasm. The level of anaesthesia must be assessed before they are inserted. Nasal airways, less stimulating to the patient, can cause significant nasal trauma and bleeding and should be used with extreme caution in patients with known coagulopathy or nasal deformities. These devices are contraindicated in the patient with basilar skull fracture. c) The Laryngeal Mask Airway (LMA)

The LMA is composed of a small ''mask'' designed to sit in the hypopharynx, with an anterior surface aperture overlying the laryngeal inlet. The rim of the mask is composed of an inflatable silicone cuff which fills the hypopharyngeal space, creating a seal that allows positive pressure ventilation with up to 20 cm H2O pressure. The adequacy of the seal is dependent on correct placement and appropriate size. Attached to the posterior surface of the mask is a barrel (airway tube) which extends from the mask's central aperture through the mouth and can be connected to an ambu bag or an anaesthesia circuit. It has gained widespread use in the practice of anaesthesia and in the securing of the airway by paramedics. A range of sizes are available for use in neonates through adults . d) Tracheal intubation: Introduction of an endotracheal tube is the gold standard for maintenance of the airway in unconscious patients. Prior to performing an intubation, the following equipment should ideally be immediately available

Table-1 Oxygen source Self inflating ventilation bag Face mask Oropharyngeal and nasopharyngeal airways Tracheal tubes Tracheal tube stylet Syringe tube for trachela tube cuff inflation Suction apparatus Laryngoscope handle (20 , tested for battery order and battery freshness Laryngoscopes blades: common blades include curved(Macintosh) and straight (Miller) Pillow, towel, blanket, or foam for head positioning Stethoscope