Awake intubation in a patient with huge orocutaneous fistula: a case report.

Awake intubation in a patient with huge orocutaneous fistula: a case report.

J Dent Anesth Pain Med. 2017 Dec;17(4):313-316

Authors: Kim HJ, Kim SH, Kim TH, Yoon JY, Kim CH, Kim EJ

Abstract
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.

PMID: 29349354 [PubMed]

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