Use of remifentanil for awake fiberoptic intubation in a morbidly obese patient with severe inflammation of the neck.
Impending upper airway obstruction due to odontogenic facial and cervical spreading infection is a potential fatal situation that requires urgent treatment. In particular, securing the threatened airway is a priority and a precondition to the pressing need for surgery. The best approach to establish the difficult airway is awake fiberoptic intubation or scheduled tracheotomy under local anesthesia. We report a critical case of severe swelling of the neck in a morbidly obese patient with no alternative to awake fiberoptic intubation. The primary goals of optimal safety for the patient and appropriate intubating conditions for the anesthesiologist made us to consider a new method of patient medication.
Puchner
W
W
Department of Anesthesia and Intensive Care Medicine, General Hospital Linz, Linz, Austria. wolfgang.puchner@akh.linz.at
Obwegeser
J
J
Pühringer
F K
FK
D000402:Airway Obstruction / Q000150:complications; D000701:Analgesics, Opioid; D005336:Fiber Optic Technology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000000981:diagnostic imaging; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D009767:Obesity, Morbid / Q000150:complications*; D010880:Piperidines; D000077208:Remifentanil; D015656:Respiratory Mechanics / Q000502:physiology; D014057:Tomography, X-Ray Computed
D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil