Conscious Sedation and Awake Fiberoptic Intubation in a Patient with Difficult Mask Ventilation—A Case Report

Abstract

Since maxillofacial malignancy is a common cause of facial defects and disfigurement of the face that may make fitting of a mask difficult and cause air leakage from the side, thus making mask ventilation difficult. In addition, distorted anatomy of the airway and base of the skull in such patients may cause difficult intubation (DI). We experienced a case with a huge facial defect due to maxillary carcinoma, in which difficult mask ventilation (DMV) and DI were predicted. After evaluation by three-dimensional airway computed tomography, the airway was secured with conscious sedation using dexmedetomidine, and awake fiberoptic intubation was safely performed. Three-dimensional airway computed tomography seems to be a good tool for successful intubation when DMV and DI are predicted.

Failed Mask Ventilation due to Air Leakage around the Orbit in a Patient with a History of Radical Maxillofacial Surgery with Orbital Exenteration

“…Anaesthesiologists may select awake intubation in patients with facial defects or disfigurement (7). In 38 claims regarding anticipated difficult airways in an American Society of Anesthesiologists (ASA) closed-claims analysis, the first strategy was more likely to be intubation after the induction of general anaesthesia (followed by failed ventilation)with ventilation ablated (61%) than awake intubation (32%) (8).…”