J Korean Dent Soc Anesthesiol.  2013 Dec;13(4):189-193. 10.17245/jkdsa.2013.13.4.189.

Difficult Airway Management with Fiberoptic Bronchoscopy Combined with Video Laryngoscope in a Patient with Ludwig Angina

• Kim S
• Song J
• Bae JH

• KMID: 2345010
• DOI: http://doi.org/10.17245/jkdsa.2013.13.4.189

Abstract

We experienced difficult airway management in a patient who had Ludwig angina with morbid obesity, difficulty with mouth opening and neck extension. We planned to perform awake-nasotracheal intubation with fiberoptic bronchoscopy but the patient's condition was not suitable to do this procedure. Thus, we tried fiberoptic nasotracheal intubation under general anesthesia but we experienced difficult airway management due to epistaxis. We tried to use video laryngoscope instead of fiberoptic bronchoscopy but also failed to guide the tube into trachea due to limited mouth opening. We used video laryngoscope to make a view of vocal cord and used fiberoptic bronchoscope as an intubation guide of endotracheal tube and successfully intubated the patient.

Keyword

Airway obstruction; Difficult airway; Fiberoptic bronchoscopy; Ludwig angina; Video laryngoscope

MeSH Terms

Airway Management*
Airway Obstruction
Anesthesia, General
Bronchoscopes
Bronchoscopy*
Epistaxis
Humans
Intubation
Laryngoscopes*
Ludwig's Angina*
Mouth
Neck
Obesity, Morbid
Trachea
Vocal Cords