Awake intubation in a patient with huge orocutaneous fistula: a case report.
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.
['Kim|Hye-Jin|HJ|https://orcid.org/0000-0003-1630-0422', 'Kim|So-Hyun|SH|https://orcid.org/0000-0002-8903-2820', 'Kim|Tae-Heung|TH|https://orcid.org/0000-0002-1361-4007', 'Yoon|Ji-Young|JY|https://orcid.org/0000-0002-9097-0531', 'Kim|Cheul-Hong|CH|https://orcid.org/0000-0003-1536-9460', 'Kim|Eun-Jung|EJ|https://orcid.org/0000-0003-4982-9517']
Orocutaneous Fistula Difficult Mask Ventilation Mandibular Reconstruction