1.        “ ......While not targeting airway manipulation, an exhibit
from UMDNJ-RWJ in New Jersey dealt with a common related
problem by featuring
a new type of face tent intended to provide
supplemental oxygen to sedated patients having upper endoscopy
involving a bite block holding the mouth open while avoiding the
common problem of CO2 rebreathing in prior efforts of this

John H. Eichhorn: ASA Meeting Exhibits Feature Safety Themes:
Airway Issues Persist as Prime Focus.
Anesthesia Patient Safety
Foundation Newsletter
Winter 2006-2007, p74-75.

2.        “......A large team from Robert Wood Johnson in New Jersey
a simple concept for use during monitored anesthesia
care when the patient needs supplemental oxygen for safety and
has nasal cannulae placed. In essence, a plastic bag is used to make
a tent over the patient’s face in a specific manner to specifically
prevent CO2 rebreathing but that raises the enclosed FiO2 to over

John H. Eichhorn: ASA Meeting Exhibits Sharpen Patient Safety
Anesthesia Patient Safety Foundation Newsletter Winter
2007-2008, p69-71.

3.        Oh, Say Can You ‘TSE’?
Simple Sheet Prevents Oxygen Desaturation During Sedation

Larry Beresford: Anesthesiology News 35 (1):30/32, 2009  

"A simple plastic sheet used as a makeshift oxygen face tent can
improve oxygenation and prevent desaturation in sedated, high-risk
patients on nasal cannula oxygen undergoing transesophageal

This plastic sheet—a clean, clear specimen bag or even the plastic
wrapper for the nasal cannula unit delivered to the operating
room—is known as the TSE “mask.” That moniker results from its
ability to convert an ineffective nasal cannula into a Technically
Simple and Effective face tent.

James Tse, MD, professor of anesthesiology at UMDNJ-Robert
Wood Johnson Medical School in New Brunswick, N.J., developed
the mask in 2001 and has since demonstrated his deceptively
simple invention to health care providers in the United States,
Australia, Hong Kong, Denmark and Canada.

“We were called upon to perform off-site anesthesia in a remote
infertility clinic and a busy endoscopy suite,” Dr. Tse said. “The
mask started as a survival technique to gain time to manage
respiration depression caused by airway obstruction or

Dr. Tse and his colleagues have touted the mask’s benefits for
patients undergoing upper endoscopy and a variety of other

“This extremely simple idea of putting a plastic bag over a sedated
patient’s face does appear to increase inspired oxygen enough to
enhance hemoglobin saturation by creating an oxygen-rich
environment around the patient’s nose and mouth,” said John H.
Eichhorn, MD, professor of anesthesiology at the University of
Kentucky in Lexington, who reviewed the TSE mask for the
newsletter of the Anesthesia Patient Safety Foundation.

“As long as there is enough fresh gas flow to flush out expired
carbon dioxide and structure to prevent the plastic from obstructing
the airway,” Dr. Eichhorn said, “there seems no downside for awake
TEE patients who really need supplemental oxygen to remain safe.”
Please go to the following link to read the full article.

4.        From a large New Jersey group, an updated and more
elaborate version of a “technically simple and effective” face tent
fashioned essentially from a plastic bag was presented
demonstrating the transformation of basic nasal cannula
administration of oxygen into a much higher concentration (40-
60%) delivery device. This also facilitates CO2 sampling for
ventilation monitoring and is intended for use during MAC or TIVA
cases in virtually any patient position.
John H. Eichhorn: ASA Meeting Exhibits Sh0wcase Patient Safety
Anesthesia Patient Safety Foundation Newsletter Winter
TSE "Mask"

5.        "Exhibits Feature Patient Safety Strategies
at ASA Meeting"
by John H. Eichhorn, M.D...... during MAC
and TIVA, including a return of the demonstration of a face tent
fashioned essentially from a plastic bag demonstrating the
transformation of basic nasal cannula administration of oxygen
into a much higher concentration (40-60%) delivery device-while
also facilitating CO2 sampling for ventilation monitoring......APSF
Newsletter Winter 2009-2010, page 60
APSF newsltter winter2009-10
6.        "Scientific Papers Highlight Patient Safety
at the 2012 ASA Annual Meeting"
by Steven B.
Greenberg, M.D., Glenn S. Murphy, M.D., Jeffery S. Venter, M.D.
Over 1,500 abstracts were presented at the 2012 ASA AM in
Washington, DC..... This brief review will highlight several
abstracts discussed at the meeting.  
  1.       Monitoring For Consciousness and Respiratory
.....Another study (A768) examined whether a TSE mask (face tent
mask) was more efficient than high nasal cannula oxygen flow in
reducing severe desaturation events in patients undergoing deep
propofol sedation during upper GI endoscopy. Two cohorts of
patients were evaluated, those with a TSE mask (N=171) and
those with a nasal cannula only (N=64). The data demonstrated
that the TSE mask was more effective than nasal cannula high
oxygen flow in reducing severe desaturation events requiring bag-
mask ventilation (A768)...APSF Newsletter Winter 2013, page 60-
ASPF Newletter winter 2013

7.     "Patient Safety Theme at ASA Meeting
Echoed in Exhibits"
by John H. Eichhorn, MD

"Another exhibit, from
Robert Wood Johnson University
concerned patients set on fire during MAC procedures
on the upper body when there is open delivery (nasal cannulae
or mask) of supplemental O2 under a drape over the face (a
recent topic of articles and editorials in the national
anesthesiology literature). Inappropriate electrocautery use in the
O2-enriched surgical field atmosphere ignites a sponge, towel, or
drape (or even residual alcohol-based skin prep solution), thus
burning the patient, often severely.
The presenters showed a
modification of a previously presented face mask for the
patient that is fashioned from a clear plastic face shield often
worn by surgeons in the OR. The unit functions to prevent
the supplemental O2 from pooling under the drapes and
leaking into the surgical field."   
(see Home Page Photos 13-15)
1)      2008 New York State Society of Anesthesiologists (NYSSA) 62nd Post Graduate Assembly
(PGA) "Best Exhibit for Clinical Application";
2)      2011 New Jersey Society of Anesthesiologists (NJSSA) 52nd Annual Spring Meeting 3rd
Place Award;
3)        2013 NJSSA 54th Annual Spring Meeting 2nd Place Award;
4)        2013 the Society of Ambulatory Anesthesia (SAMBA) “$1000 Resident Travel Award”;
5)        2013 NYSSA 67th PGA  “Best Exhibit for Clinical Application”;
6)        2014 the American Society of Anesthesiologists (ASA) Scientific Educational Exhibits        
3rd Place Award;
7)        2014 the Anesthesia Patient Safety Foundation (APSF) Ellison C. Pierce, Jr., MD Award
for "Best Scientific Exhibit for Patient Safety";
8)        2015 NYSSA 69 thPGA "Best Exhibit for Clinical Application";
9)        2016 NYSSA 70th PGA "Best Exhibit for Clinical Application";
10)      2019 NJSSA 60th Annual Spring Meeting Best MCC Award
2014 3rd Place Award for Scientific/Educational Exhibit at the ASA Annual Meeting,
New Orleans, LA, Oct 2014,
(Feb 2015 ASA Newsletter, page 40-41)
Anesthesia Patient Safety Foundation E.C. Pierce, Jr., MD, Award for Best
Scientific Exhibit
(APSF Newsletter February 2015, page 48).
8.      Anesthesiology News

NOVEMBER 16, 2016

Novel Nasal PAP Mask Assembly Improves Oxygenation,
Check the link for video AnesthesiologyNews video

New York—Delivering continuous positive airway pressure (CPAP) with novel nasal PAP mask
assembly is an effective technique for improving safety in patients receiving an interscalene
block and sedation for shoulder arthroscopy, new research suggests.

Some people may be given a sedative after a regional peripheral nerve block. Desaturation
commonly occurs in patients receiving moderate to deep sedation, according to researchers from
Rutgers Robert Wood Johnson Medical School, in Piscataway Township, N.J. Supplemental
oxygen supplied through a nasal cannula is often insufficient for maintaining adequate

The original technically simple and effective (TSE) mask, a 12-by-12–inch plastic sheet used to
cover a patient’s nose and mouth, has been shown to increase oxygenation during upper
endoscopy, providing a fraction of inspired oxygen of 40% to 60% with oxygen flows of 4 L per
minute via nasal cannula (Anesthesiology 2005;102:484). The researchers presented a case
study showing the efficacy of the nasal TSE-PAP mask assembly for maintaining oxygen
saturation in a patient with autonomic neuropathy under regional anesthesia supplemented by
“What we did in this case is take an infant mask attached over the patient’s nose with head
straps and connect it to a long breathing circuit with continuous positive airway pressure via the
anesthesia machine,” said Dennis Warfield Jr., MD, lead study author and second-year
anesthesia resident at the institution. “This enables the airway to maintain patency and provide
continuous oxygenation.”

The patient was a 68-year-old woman who presented for arthroscopic incision and drainage for
an infected right shoulder after two failed rotator cuff repairs. Autonomic neuropathy, which
occurs when nerves that control involuntary functions are damaged, is commonly related to
having a prolonged history of diabetes, according to Dr. Warfield.

“However, in our patient it was a sequelae of a major diarrheal illness,” he said. “She came to us
after two failed rotator cuff repairs and unsuccessful medical management and surgical treatment
to try to relieve the autonomic neuropathy.”

The patient reported poor response to antihypertensive treatment due to profound hypotension,
and had two failed medullary decompression surgeries. Her preoperative vital signs on the day of
surgery included a blood pressure of 226/131 mm Hg and heart rate of 134 beats per minute.
“What we decided to do was avoid general anesthesia in an attempt to circumvent extreme
lability in blood pressure,” Dr. Warfield said. “We decided to conduct regional anesthesia with a
one-shot interscalene block in addition to sedation.”

The patient was placed in the sitting position. The researchers administered an ultrasound-
guided right interscalene one-shot block of 30 cc of 2% lidocaine hydrochloride and epinephrine
1:200,000 injection. The patient also received 2 mg of midazolam and 100 mcg of fentanyl before
the block, and was given the same doses at the beginning of the procedure.

The researchers secured the TSE-PAP mask assembly over the patient’s nose with head straps
and connected it to the anesthesia machine, delivering 6 cm of water CPAP with 2 L of oxygen
per minute and 2 L of nitrous oxide per minute.

The patient maintained spontaneous respiration and had 100% oxygen saturation throughout the
case, the researchers reported.

“There were no significant swings in blood pressure or heart rate,” Dr. Warfield said. “She was
able to maintain her oxygen saturation throughout the case and was discharged later on the
same day.”

He noted that the noninvasive technique’s low cost is another benefit to using it to improve
oxygenation and safety in sedated patients.

“It’s a very cheap alternative, and the equipment that we used is found in the majority of today’s
operating rooms,” he said.

The findings were presented at the 2016 New York School of Regional Anesthesia’s annual
symposium (poster P8).
—Martin Leung
9. Blog Review

Blog: Glidescope Jack
Post: Near Perfection in Airway Management is now Possible #4

Monday, February 19, 2018

Nasal Oxygen Delivery- Profound Discovery.

"........Modified Pediatric Nasal Mask

James Tse- Legendary work demonstrating Rescue with Nasal Tse PAP (Use of a modified Pediatric
facemask) allows positive pressure ventilation via nasal route, intubation with GlideScope (highly
angled feature is important) , without removal of the nasal mask. Thus a high oxygen environment
and flexibility is maintained while the enhanced nasal route pressure CPAP tends to keep the tongue
and pharynx open. Dr. Tse has presented multiple times at ASA and SAM winning the anesthesia
safety foundation award. This strategy is very economical with oxygen use......"
10. POST: DocMatter

Title: Simple Technique to Reduce Aerosol/Droplet Spread while Providing Continuous Nasal
Oxygenation during RSI and Intubation/Extubation

“With COVID cases still on the rise, I thought I would present a simple, inexpensive solution that I’
ve been using to reduce aerosol/droplet spread during RSI and intubation/extubation while
providing continuous nasal oxygenation

We combined a plastic sheet and a pediatric face mask to create a combined nasal mask-face tent.
Attached are two posters we presented in which we used this technique for two patients: a COVID-
19 positive patient during GA induction, intubation and extubation and a morbidly obese patient
with a difficult airway and severe COPD.

Hopefully you all find this a helpful method to increase provider safety beyond PPE and potentially
patient safety as well. Additional information can be found at www.TseMask.com.

What techniques outside of PPE have others been using to increase patient and provider safety?
Are there some techniques that can maintain in our practices even when COVID is less of a

Posted 2/19/21 at www.docmatter.com & taken down on March 4, 2021.

“Dear Dr. Tse,

I want to first thank you for your participation on DocMatter. You may be interested to know that
your posts and responses are approaching 4000 views, so I know your colleagues have
appreciated your input. ….. “