Three difficult airway management strategies in the same patient at three different times

Abstract

Unpredictable difficult intubation is a commonly faced clinical issue and one of the most important reasons of morbidity related to anesthesia. We present a case of a 50 y old, 100 kg, 1.8 m tall (BMI=37) male patient, taken to OR (transoral robotic) for a planned biopsy because of a mass in his larynx. Videolaryngoscope was used two times but still intubation was unsuccessful. Fiberoptic bronchoscope (FOB) assisted nasotracheal intubation was chosen to be used. Intubation was unsuccessful even after two attempts by a highly experienced anesthetist. After that, face mask was applied and ventilation started. Then blind oral intubation by the same anesthetist was attempted and it was successful. Ten days later, FOB guided nasal intubation was successful and 7 days later tracheostomy had to be done to secure airway. We stress that even for an apparently an easy airway the anesthetist needs to be ready to face every challenge and execute different strategies one by one when facing difficult airway scenario.