Management of the difficult airway A case of failed fiberoptic intubation
- 1 September 1997
- journal article
- case report
- Published by Wiley in Acta Anaesthesiologica Scandinavica
- Vol. 41 (8), 1080-1082
- https://doi.org/10.1111/j.1399-6576.1997.tb04841.x
Abstract
Background: Fiberoptic intubation is the current gold standard for the management of difficult intubation. Nevertheless, in rare circumstances even fiberoptic intubation fails. Methods: We describe the case of a female patient suffering from neurofibromatosis Recklinghausen and a giant malignant schwannoma on the neck obstructing the pharynx and compromizing respiration. Based on the clinical presentation and the MRI findings, difficulties in airway management were anticipated and fiberoptic intubation of the awake patient was planned. Results: After localizing the vocal cords it was not possible to advance the tube into the trachea due to the severe deviation of the glottis. A decision was made to cancel any further fiberoptic intubation attempts and a conventional tracheotomy was performed under local anaesthesia without problems. Conclusion: This case illustrates that even awake fiberoptic intubation has its failure rate, due to inability to visualize the larynx, inability to advance the tube over the fiberscope (as in the present case), or inability to direct the tube towards the larynx. Due to the extreme deviation of the larynx other established techniques for difficult intubation were not deemed appropriate in this case. Therefore, weighing the risks and benefits, a decision was made to perfom a tracheotomy under local anaesthesia.Keywords
This publication has 8 references indexed in Scilit:
- Die schwierige IntubationDer Anaesthesist, 1996
- Overcoming Obstruction During Bronchoscope-Guided Intubation of the Trachea with the Double Setup Endotracheal TubeAnesthesia & Analgesia, 1996
- Overcoming Obstruction During Bronchoscope-Guided Intubation of the Trachea with the Double Setup Endotracheal TubeAnesthesia & Analgesia, 1996
- Cervical haematoma and airway obstructionBritish Journal of Anaesthesia, 1996
- Airway problems after carotid endarterectomyBritish Journal of Anaesthesia, 1996
- Practice Guidelines for Management of the Difficult AirwayAnesthesiology, 1993
- Fiberoptic Nasotracheal Intubation???Incidence and Causes of FailureAnesthesia & Analgesia, 1983