MANAGEMENT OF THE DIFFICULT AIRWAY - A CASE OF FAILED FIBEROPTIC INTUBATION

Background: Fiberoptic intubation is the current gold standard far the management of difficult intubation. Nevertheless, in rare circumstanc es 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 co mpromizing respiration. Based on the clinical presentation and the MRI findings, difficulties in airway management were anticipated and fibe roptic intubation of the awake patient was planned. Results: After loc alizing the vocal cords it was not possible to advance the tube into t he trachea due to the severe deviation of the glottis. A decision was made to cancel any further fiberoptic intubation attempts and a conven tional tracheotomy was performed under local anaesthesia without probl ems. Conclusion: This case illustrates that even awake fiberoptic intu bation 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 diffi cult Intubation were not deemed appropriate in this case. Therefore, w eighing the risks and benefits, a decision was made to perfom a trache otomy under local anaesthesia.