Awake Glidescope® intubation in a patient with a huge and fixed supraglottic mass -A case report-

Abstract

Intubating patients with a huge, fixed supraglottic mass causing an obstruction of the glottis is difficult to most anesthesiologists. We attempted awake fiberoptic orotracheal intubation assisted by Glidescope® Videolaryngoscope (GVL) following topical anesthesia with 4% lidocaine spray and remifentanil infusion. The glottis could not be identified by the GVL view. However, by entering toward the right side of the mass with bronchoscope, the glottis was found. Due to stiffness of the mass, we were unable to further enter the area using the bronchoscope. Alternatively, we attempted to expose the glottis by GVL blade and then successfully intubated the patient by manually pressing the cricoids cartilage. GVL is nonetheless an excellent instrument in airway management compared to fiberoptic bronchoscope for patients with a huge and fixed supraglottic mass.

Keywords: Difficult airway; Fiberoptic bronchoscope; Glidescope; Stylet; Supraglottic mass.

Fig. 1

Identifying the glottis and attempting intubation using a fiberoptic scope under GVL through the right side of the mass. Black arrow shows a large supraglottic mass blocking most of the airway. The mass is round and well-encapsulated.

Fig. 2

Identifying a part of the glottis and attempting intubation using a stylet inserted tracheal tube assisted by GVL blade and manually pressing the cricoids cartilage to successfully intubate the patient. Black arrow shows epiglottis deviated to the right due to supraglottic mass.