Fiberoptic nasopharyngoscopy for evaluating a potentially difficult airway in a patient with elevated intracranial pressure |
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Institution: | 1. University of Mississippi Medical Center, Jackson, MS;2. The Ohio State University Wexner Medical Center, Columbus, OH;1. Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA;2. North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, FL, USA;1. Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France;2. Department of Anesthesiology, Centre Hospitalier Departemental, La Roche sur Yon, France |
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Abstract: | A 62-year-old man with a left temporal lobe tumor was scheduled for a semiurgent craniotomy for tumor excision. Previously, the patient had a laryngeal carcinoma that was resected and treated with chemotherapy and radiotherapy and a history of laryngeal biopsy with awake fiberoptic intubation. Because a difficult airway was anticipated, awake fiberoptic nasopharyngoscopy of the airway was performed under topical anesthesia in the operating room. This revealed a narrow glottic opening with no supraglottic pathology or friable tissue. Based on these airway observations, we proceeded safely with intravenous induction and secured the airway in a controlled fashion, thereby minimizing the risk of increased intracranial pressure and catastrophic complications. Nasopharyngoscopy can be used safely to evaluate the upper airway to stratify airway management in patients with a history of head and neck cancer presenting for neurosurgical procedures in the setting of elevated intracranial pressure. |
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