Combined awake videolaryngo-bronchoscopy intubation with HFNC preoxygenation for predicted difficult airway in a patient with post-burn mentosternal scar contracture.

Abstract

Airway management and safety remain a difficult challenge during reconstructive surgery in patients with extensive post-burn mentosternal scar contractures. Current guidelines do not recommend the use of direct laryngoscopy for predicted difficult airway because of the risk of intubation failure and airway emergencies: the consequences of wrong decisions can be fatal, and the patient is at serious risk. At present, video-laryngoscopy is the most commonly used technique for routine orotracheal intubation. Awake tracheal intubation with fibro-bronchoscopy also remains a valid option when possible, ensuring the patient's spontaneous breathing during the procedure. However, when videolaryngoscopy is used in combination with this method, the efficiency of these devices can be increased, and a better result can be achieved. We report a case of successful management of a predicted difficult airway with combined video laryngo-bronchoscopy in an awake patient with post-burn neck scar contractures.