J Dent Anesth Pain Med.  2017 Dec;17(4):313-316. 10.17245/jdapm.2017.17.4.313.

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

• Kim HJ
• Kim SH
• Kim TH
• Yoon JY
• Kim CH
• Kim EJ

• KMID: 2399802
• DOI: http://doi.org/10.17245/jdapm.2017.17.4.313

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.

Keyword

Difficult Mask Ventilation; Mandibular Reconstruction; Orocutaneous Fistula

MeSH Terms

Airway Management
Anesthesia, General
Dexmedetomidine
Female
Fistula*
Humans
Intubation*
Intubation, Intratracheal
Laryngoscopes
Mandibular Reconstruction
Masks
Middle Aged
Neck Dissection
Thigh
Ventilation
Dexmedetomidine

Figure

• 

  Fig. 1 The picture of huge orocutaneous fistula and exposed reconstruction plate.

Reference

1. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. sedation, ventilation, and metabolic rate. Anesthesiology. 1992; 77:1125–1133. PMID: 1361310.

2. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The richmond agitation-sedation scale: Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002; 166:1338–1344. PMID: 12421743.

3. Han R, Tremper KK, Kheterpal S, O'Reilly M. Grading scale for mask ventilation. Anesthesiology. 2004; 101:267. PMID: 15220820.

4. Cook TM, Woodall N, Frerk C, Fourth National. Major complications of airway management in the UK: Results of the fourth national audit project of the royal college of anaesthetists and the difficult airway society. part 1: Anaesthesia. Br J Anaesth. 2011; 106:617–631. PMID: 21447488.

5. Stackhouse RA. Fiberoptic airway management. Anesthesiol Clin North America. 2002; 20:933–951. PMID: 12512270.

6. David L, Mark S. Awake intubation. Contin Educ Anaesth Crit Care Pain. 2015; 15:64–67.

7. Yumul R, Elvir-Lazo OL, White PF, Durra O, Ternian A, Tamman R, et al. Comparison of the C-MAC video laryngoscope to a flexible fiberoptic scope for intubation with cervical spine immobilization. J Clin Anesth. 2016; 31:46–52. PMID: 27185677.

8. Shirgoska B, Netkovski J. New techniques and devices for difficult airway management. Acta Clin Croat. 2012; 51:457–461. PMID: 23330414.

9. Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society. Difficult airway society guidelines for management of the unanticipated difficult intubation. Anaesthesia. 2004; 59:675–694. PMID: 15200543.

10. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: An updated report by the american society of anesthesiologists task force on management of the difficult airway. Anesthesiology. 2003; 98:1269–1277. PMID: 12717151.

11. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000; 90:699–705. PMID: 10702460.