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.