RESUMO
Introduction: Difficulty in mask ventilation is quitechallenging to an anaesthesiologist because mask ventilation isthe primary technique of ventilation and the rescue techniqueif the tracheal intubation fails. Unanticipated difficulty in maskventilation is even more challenging to the anaesthesiologist.Case report: Here we report a case of unanticipated difficultmask ventilation due to cystic swelling on left side ofepiglottis.Conclusion: Prudent and cautious corrective measures takenat the right time, ensures patient safety
RESUMO
Mask ventilation, the first step in airway management, is a rescue technique when endotracheal intubation fails. Therefore, ordinary airway management for the induction of general anesthesia cannot be conducted in the situation of difficult mask ventilation (DMV). Here, we report a case of awake intubation in a patient with a huge orocutaneous fistula. A 58-year-old woman was scheduled to undergo a wide excision, reconstruction with a reconstruction plate, and supraomohyoid neck dissection on the left side and an anterolateral thigh flap due to a huge orocutaneous fistula that occurred after a previous mandibulectomy and flap surgery. During induction, DMV was predicted, and we planned an awake intubation. The patient was sedated with dexmedetomidine and remifentanil. She was intubated with a nasotracheal tube using a video laryngoscope, and spontaneous ventilation was maintained. This case demonstrates that awake intubation using a video laryngoscope can be as good as a fiberoptic scope.