Difficult intubation in critical patient: how can we manage it? a case report

Difficult airway management represents a challenge. Guidelines recommend choosing the airway techniquebased on physicians’ skills, equipment, available devices and context.A man with acute respiratory failure needed an emergent intubation. He was obese with Mallampati score 4,Cormack-Lehane grading 4, macroglossia, reduced mouth opening, stocky and wide neck, and deviated laryngo-trachealaxisduetoexpandingneckhematoma.Afterendotrachealintubationfailure,theanesthetistplacedasecond-generationlaryngealmaskairwayandstartedventilation.Inthenextstep,definiteairwaywasprovidedbyanendotrachealtubeplacedthroughthemaskunderflexiblefiberscopevision.Supraglotticairwaydevicesarerecommendedincasesofunanticipateddifficultintubationafterendotrachealintubationfailure.Theyareusedtoensuresatisfactoryoxygenationandoccasionallytoguidetheendotrachealtube.Fiberscopeisusefultoensurevisionoflarynxandtracheainthesescenarios.Thisisauniquecaseofemergencyanddifficultairwaymanagementusingthiscombinedapproach