FIBEROPTIC INTUBATION: AN ALTERNATIVE TO TRACHEOSTOMY? A CASE REPORT

Author: 
Dr Sakshi Arora*, Dr B.P.Singh and Dr Ishoo Rai Taneja
Country: 
India
Abstract: 

Awake FOB is the gold standard for difficult airway. We have guidelines for intubating a patient with various airway difficulties, but very little literature is available for extubation and reintubation of a difficult airway. Thus, we are reporting this case with difficult airway,when even surgical airway access  failed. A 30 year old male patient known case of congenital bilateral temporomandibular joint ankylosis was posted for complete ankylotic block excision and subsequent arthroplasty. He has been operated for the  same twice. A wake fiberoptic intubation was done and surgery continued for four hours, uneventful. Post extubation patient developed laryngospasm and not reversed with medical therapy, meanwhile we lost the airway & were unable to reintubate him. ENT surgeon was called meanwhile for tracheostomy and he happened to cut the anterior juglar vein and patient started bleeding profusely. Oxygen was insufflated through left nostril via nasophryngeal airway @15lt/min. As we lost the surgical access to  airway we tried to reintubate the trachea with the help of fiberoptic bronchoscope through right nostril. We visualized clearly through FOB and intubated with cuffed ETT. Difficult airway management remains one of the most important sources of anesthesia related accidents;  recent reviews and dedicated guidelines suggest that not only intubation, but extubation too is a critical phase in terms of potential accidents and serious complications.

KeyWords: 

Fiberoptic Intubation, Difficult Airway, Extubation

Volume & Issue: 
Vol. 5,Issue, 06
Pages: 
1483-1485
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