Innovative airway management for peritonsillar abscess.
OBJECTIVE
To describe innovative airway management in an adult with a peritonsillar abscess (quinsy) located atypically in the inferior pole of the palatine tonsil.


METHODS
A 25-yr-old male was admitted for surgical drainage of a left-sided, inferior pole peritonsillar abscess. Previous attempts at intraoral needle and scalpel drainage with topical anesthesia in the emergency department had failed. He had an interdental distance of 1.5 cm and computed tomography imaging showed narrowing of the airway diameter to 8 mm and lateral displacement of the epiglottis. He gargled 10 mL 0.5% lidocaine in the sitting position. We advanced a 3.1-mm pediatric fibreoptic bronchoscope (FOB) through an orally inserted nasopharyngeal airway to identify the glottis and sprayed 0.5% lidocaine onto the airway mucosa. We replaced the airway with a reinforced 6.5-mm internal diameter tracheal tube (TT), advanced the FOB through it until its tip was just above the carina, and then advanced the TT into the trachea. After iv induction of general anesthesia, the surgeon performed a tonsillectomy and drained the neck abscess. Postoperative direct laryngoscopy revealed a markedly improved airway lumen and tracheal extubation over a Cook Airway Exchange Catheter was uneventful. The patient was stable in the recovery room, and was discharged on the third postoperative day.


CONCLUSIONS
We present an innovative technique of fibreoptic intubation in an awake patient with an inferior pole peritonsillar abscess.
Beriault
Michael
M
Department of Anesthesiology, Foothills Medical Center, 1403-29 St. N.W., Calgary, Alberta T2N 2T9, Canada. beriaul@telusplanet.net
Green
Jennifer
J
Hui
Anita
A
D000328:Adult; D000402:Airway Obstruction / Q000517:prevention & control; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage; D001999:Bronchoscopy / Q000379:methods; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D000039:Peritonsillar Abscess / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods
D000779:Anesthetics, Local; D008012:Lidocaine