Recommended Citation
Siddiqui A, De Ranieri A. Awake fiberoptic intubation in a patient with radiated vocal cord squamous cell carcinoma (SCC) for an urgent femoral fracture repair. Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Presentation Notes
Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Abstract
Introduction: Awake fiberoptic intubation (AFOI) is useful in managing patients with a known history of difficult airway including airway obstruction, masses or stenosis. The ideal method includes education, divided doses of sedation and analgesia as well as topical lidocaine to keep the patient both comfortable and compliant. Case Presentation: A 85 y/o F with a PMH of oxygen dependent COPD, CAD s/p PCI, poorly controlled HTN, SCC of the tongue and epiglottis with vocal involvement s/p radiation (last 3 months prior), diaphragmatic hernia, dementia, and sensorineural hearing loss with plans for THA due to instability. PE was Mallampati III with decreased TM distance and poor mouth opening. Of note, she underwent AFOI in 01/2024 for biopsy of SCC. After obtaining consent and education for the procedure, a small dose of midazolam was given for relaxation. We then performed AFO evaluation in the pre-operative area. The vocal cords were visualized. In the operating room, AFOI proceeded with divided doses of midazolam and antihypertensives. Our initial pass with the fiberoptic was unsuccessful. The second attempt with an anterior approach led to successful visualization of the cords and passage of a 5.0 ETT. The surgery was completed uneventfully, and the patient was extubated to a simple face mask without any issues. Conclusion: In anticipated difficult airways, thorough preoperative airway evaluation and visualization are critical in determining the optimal intubation strategy. In AFOI compliance is essential, requiring proper explanation and expectations including possible post operative intubation. Judicious doses of sedation and analgesia are important adjuncts to success in AFOI. Based on patient factors, appropriate medication selection—such as midazolam for anxiolysis—ensures adequate sedation while preserving spontaneous respiration. Analgesia selection, such as viscous lidocaine and solution via an atomizer, allows us to avoid medications that could disrupt spontaneous respiration. 1. Wong J, et al. (2019) Singapore Med J 60(3):110-118 2. Tsukamoto M, et al. (2018) J Dent Anesth Pain Med 18(5):301-304
Type
Oral/Podium Presentation
Affiliations
Advocate Illinois Masonic Medical Center