Successful rescue with videolaryngoscopy after failed fibroscopy in anticipated difficult airway: case series

Abstract


 Introduction:
 In the management of the anticipated difficult airway (DA), awake intubation is the strategy of choice. In this context, flexible fibroscopy is the tool most widely used as the first choice. However, there is always the rare case where it may fail.
 Important findings:
 
 
 Six successful rescue cases using videolaryngoscopy following failed fibroscopy in patients with anticipated DA, and 1 case of rescued extubation of an airway previously secured with fiberoptic bronchoscopy.
 Conclusion:
 
 
 Videolaringoscopy may be an adequate tool to use as a backup plan for the management of an anticipated DA.

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

“…[488][489][490][491] Case reports also observed successful intubation with videolaryngoscopes in unanticipated and emergency difficult airways (Category B4-B evidence). 160,[492][493][494][495][496] A retrospective observational study reported a flexible bronchoscopy success rate of 78% for intubation rescue after failed direct laryngoscopy (Category B3-B evidence). 488 Case reports of flexible bronchoscopy or fiberoptic **** Any one factor alone (i.e., assessed difficulty with intubation or ventilation, increased risk of aspiration or desaturation) may be of sufficient clinical importance to warrant an awake intubation.…”

“…488–491 Case reports also observed successful intubation with videolaryngoscopes in unanticipated and emergency difficult airways (Category B4-B evidence ). 160,492–496 A retrospective observational study reported a flexible bronchoscopy success rate of 78% for intubation rescue after failed direct laryngoscopy (Category B3-B evidence ). 488 Case reports of flexible bronchoscopy or fiberoptic nasotracheal intubation observed successful rescue intubations for unanticipated and emergency difficult airways (Category B4-B evidence ).…”

A case of displaced mandibular reconstruction plate and the airway

“…5 There has been several reports on failed fiberoptic intubation needing alternative plans. 5,6 In most of the situations, the backup plan would be to perform a tracheostomy under local anesthesia. In this patient, performing a tracheostomy would have been difficult due to previous tracheostomy.…”