Change to emergency cricothyroidotomy during awake fiberoptic intubation in the patient with huge tongue mass

Byeong Cheol Lee; Hyojoong Kim; Sang Eun Lee; Yong Han Kim; Se Hun Kim; Yukyung Jeon

Abstract
A 38-year-old male patient diagnosed with tongue cancer was scheduled to undergo tracheostomy to maintain the airway prior to chemotherapy. Salivary gland computed tomography showed a 4.0×4.6×5.3 cm mass on the right side of the base of the tongue. To prevent oxygen desaturation, preoxygenation was initiated with fraction of inspired oxygen 1.0 at a flow rate of 6 mL/min for. After preoxygenation, lidocaine was sprayed and infusion of remifentanil at 0.15 mcg/kg/min was initiated to reduce the irritation. When cricothyroidotomy is performed on awake patients, the risk of complications may increase because of pain, therefore, the otolaryngologist advised sedation since the patient was showing agitation. Cricothyroidotomy was performed by the otolaryngologist under a light sedation using 1.5 volume percent (vol. %) of sevoflurane, and a reinforced endotracheal tube (6.0) was inserted at the cricothyroidotomy site.
In order to minimize the occurrence of failure to deal with difficult airways, anesthesiologists should secure the patient’s airway according with difficult airway algorithms, and need to be prepared and trained to perform an invasive approach for difficult airway management in advance.

Key words: Airway management, cricothyroidotomy, difficult intubation, surgical airway, tongue cancer.

ABOUT JOURNAL About Publisher Contact Us Editorial & Peer Review Process	POLICIES Privacy Policy Editorial Policy Author's Rights and Obligations Conflict of Interest Policy Plagiarism Policy Advertising Policy	STATEMENTS Terms of Use Author's Rights and Obligations Publication Ethics and Publication Malpractice Statement Protection of Research Participants (Statement On Human And Animal Rights) License Information

This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author. This is in accordance with the Budapest Open Access Initiative (BOAI) definition of open access. The articles in Rawal Medical Journal are open access articles licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-sa/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

Indexed in Scopus, Web of Science, WHO Index Medicus IMEMR, Emromedex, Pakmedinet, ExtraMED and Tehqeeqat

How to cite this article

	Open Access and Peer-reviewed
Home Journal Issues Guide for Authors Editorial Board Aims & Scope About Journal News & Announcements