Key Clinical Message
A safe and comfortable intubation with spontaneous breathing keeping was
achieved in a patient with severe postburn mentosternal contracture and
refused to accept awake intubation, which can be expanded to other
patients with difficult airway.
Abstract
Airway management of patients with difficult airways is a challenge to
the anesthesiologists and awake tracheal intubation is the recommended
strategy. A safe, comfortable, unconscious, and satisfied intubation
with spontaneous breathing keeping was achieved by intermittent
sevoflurane inhalation and the modified spray-as-you-go technique for
airway topicalization and intubation.
Key words: Awake
intubation, difficult airway, sevoflurane, spray-as-you-go.
Introduction
Airway management of patients with postburn mentosternal contracture is
a challenge to the anesthesiologists [1,
2]. Awake tracheal intubation (ATI) has
been recommended as the gold standard in airway management for
anticipated difficult airway [3].
However, ATI needs patients’ cooperation and may leave a discomfort and
nociceptive recall to patients, which leads to the rejection of ATI in
the next surgery. We described a patient with severe post-burn
contracture refused ATI due to the unsuccessful experience before, a
comfortable and unconscious endotracheal intubation with spontaneous
breathing keeping was achieved by the combination of intermittent
sevoflurane inhalation and the modified spray-as-you-go (SAYGO)
technique using flexible bronchoscopy.