Fiber Optic IntubationThree Case Reports

Reid Rubsamen, M.D.

Known Difficult Intubation

• Case Report– 63 y/o woman for left breast lumpectomy and

node dissection– Known difficult intubation– Easy to mask ventilate for previous surgery

Known Difficult Intubation

• Case Report (Continued)– General anesthesia induced with

propofol/fentanyl/cisatracurium– Tongue withdrawn by assistant holding gauze

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Pharyngeal Carcinoma

• Case Report– 75 y/o man with oral pharyngeal carcinoma

for open G-Tube placement– Mouth opens 3cm at teeth

Pharyngeal Carcinoma

• Case Report (Continued)– Pre Rx midazolam– Topicalized using xylocaine ointment on

progressively larger oral airways– Xylocaine 4% sprayed x1 with Mucosal

Atomization Device (MAD)– Olympus bite-block airway inserted

• Patient’s mouth would not open to accommodate Ovassapian airway

External Tracheal Compression

• 47 y/o woman with toxic, obstructive multinodular goiter

• Progressive wheeze x 6 months

• “My endocrinologist wants to know how you’re going to get the breathing tube in”

External Tracheal Compression

External Tracheal Compression

• Case Report (Continued)– Pre Rx midazolam– Topicalized using xylocaine ointment on

progressively larger oral airways– Xylocaine 4% sprayed x1 with Mucosal

Atomization Device (MAD)– Ovassapian airway inserted

External Tracheal Compression

• Case Report (Continued)– Intraoperative comment from surgeon:

• “This patient has a small trachea”

– Nodule removed without median sternotomy– Path report:

• “Thyroid goiter 7.5cm x 6cm x 4cm”