Clinical Application Of Fiberoptic Bronchoscopy Guided Awake Tracheal Intubation In Removal Of Internal Fixation For Cervical Spine Fracture: Case Report

Background: and objectives: When planning the management of a predicted difficult airway, it is important to determine which strategy will be followed. Using fiberoptic bronchoscopy is a major option in scenarios with factors suggesting difficult airway access. It is also indicated in rescue situations, when there is tracheal intubation failure with direct laryngoscopy. The purpose of this report is to demonstrate the efficacy of using fiberoptic bronchoscopy as the preferred device for patients after cervical spine fracture surgery with almost no neck mobility and difficult airways. Case report: An 47 year-old famale patient, 168 cm, 65 kg, ASA Physical Status II, Mallampati IV classification, was scheduled for internal fixation removal surgery for cervical spine fractures. Although the patient had a difficult airway, she showed no signs of respiratory failure or airway obstruction. After entering the room, provide oxygen through a nasal catheter with a flow rate of 2 L/min. After establishing a venous pathway and monitoring, intravenous infusion of dexmedetomidine with a load of 0.5ug/kg was completed within 10 minutes. During airway preparation, always maintain the patient's autonomous breathing. The anesthesiologist performed a transcricoid puncture on the patient and injected 3mL of 2% lidocaine solution into the tracheal cavity. The whole mouth was sprayed with 2% lidocaine under the guidance of fiberoptic bronchoscope. An armored tube with a guide wire inside was used for tracheal intubation, performed on the first attempt with appropriate glottis visualization. Conclusion The fiberoptic bronchoscope occupies a prominent position in cases in which access to the airway is difficult. Fiberoptic bronchoscope guidance in awake endotracheal intubation for patients with difficult airway has the advantages of rapid, accurate, safe, high success rate and little damage. This can provide a new and effective method for the difficult airway management of these patients.