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J Dent Anesth Pain Med. 2017 Dec;17(4):313-316. doi: 10.17245/jdapm.2017.17.4.313. Epub 2017 Dec 28.

Awake intubation in a patient with huge orocutaneous fistula: a case report.

Author information

1
Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
2
Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea.
3
Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Korea.

Abstract

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.

KEYWORDS:

Difficult Mask Ventilation; Mandibular Reconstruction; Orocutaneous Fistula

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