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KMID : 0980320170170040313
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Journal of Dental Anesthesia and Pain Medicine
2017 Volume.17 No. 4 p.313 ~ p.316
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Awake intubation in a patient with huge orocutaneous fistula: a case report
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Kim Hye-Jin
Kim So-Hyun
Kim Tae-Heung
Yoon Ji-Young
Kim Cheul-Hong
Kim Eun-Jung
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Abstract
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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.
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KEYWORD
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Difficult Mask Ventilation, Mandibular Reconstruction, Orocutaneous Fistula
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