Fiberoptic Reintubation in an Unanticipated Difficult Airway: A Case Report

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Abstract
Background: Although direct laryngoscopy may seem the most reasonable modality for previously intubated patients, in the setting of anatomical distortion secondary to reconstructive neck surgery, flexible fiberpostoptic laryngoscopy (FFL) should be considered for patients who may require postoperative emergency reintubation. Case Presentation: A 51‐year‐old woman with squamous cell carcinoma of the submental triangle and larynx was referred for free flap surgery. For postoperative care, she was admitted to the ICU. After 18 h, the patient developed respiratory distress and confusion. We decided to perform awake tracheal intubation for her. After receiving a sufficient dose of fentanyl and dexmedetomidine, intubation with direct laryngoscopy was attempted, but it failed. Fortunately, the patient was intubated using an FFL available in the ICU. After 48 h, she was extubated and transferred to the surgery ward. Conclusion: Our experience suggests that, for patients who are undergoing free flap surgery in regions that jeopardize the airway, if intubation is needed (especially shortly after surgery), difficult airway management devices such as FFL should be readily accessible alongside an expert anesthesiologist.

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