Combined use of a videolaryngoscope and a flexible bronchoscope for awake tracheal intubation when front‐of‐neck airway is not an option. Issue 1 (13th January 2021)

• Record Type: Journal Article
• Authors: Khan, M. F.; Shamim, F.; Slote, M. U.; Salim, B.; Abbas, S. A.
• Is Part Of: Anaesthesia reports. Volume 9:Issue 1(2021)
• Page Start: 12
• Page End: 15
• Publication Date: 2021-01-13
• Subjects: difficult airway algorithm -- failed intubation: treatment -- upper airway anatomy; Anesthesiology -- Periodicals; 617.9605
• DOI: 10.1002/anr3.12091
• Languages: English
• ISSNs: 2637-3726

Abstract

Summary: We report a case of successful tracheal intubation with the combined use of a videolaryngoscope and flexible bronchoscope in a patient with difficult airway when both techniques had individually failed. A 35‐year‐old man presented with airway obstruction due to massive neck swelling causing hypoxia, stridor and respiratory distress. He had a history of oral cancer which had been resected with bilateral neck dissection and free flap reconstruction 2 months previously. Due to extensive anterior neck swelling, we judged that front‐of‐neck airway would not be a suitable approach. After unsuccessful attempts at awake tracheal intubation with videolaryngoscopy and flexible bronchoscopy separately, we combined both techniques with a successful outcome. By using a combined technique to address the specific problems presented by this case, a life‐threatening emergency was resolved. This case highlights why it is useful for anaesthetists to be familiar with multiple techniques to awake tracheal intubation, both individually and in combination.