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

  • Kim, Hye-Jin (Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital) ;
  • Kim, So-Hyun (Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital) ;
  • Kim, Tae-Heung (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University) ;
  • Yoon, Ji-Young (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute) ;
  • Kim, Cheul-Hong (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute) ;
  • Kim, Eun-Jung (Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute)
  • Received : 2017.11.22
  • Accepted : 2017.12.02
  • Published : 2017.12.31

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.

Acknowledgement

Supported by : Pusan National University Dental Hospital

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