title: Successful use of videolaryngoscopy in an adult patient with acute epiglottitis: a case report.
abstract: Acute epiglottitis is a potentially life-threatening infection of the supraglottic structures, which can lead to sudden, fatal airway obstruction. Different techniques have been described to facilitate tracheal intubation in acute epiglottitis. We describe the successful intubation, with the help of the videolaryngoscope, of a 60-year-old female with acute epiglottitis. On admission the patient was ill and severely distressed, sitting in the upright position, drooling saliva, showing severe inspiratory stridor, hyperventilation, but no trismus. Intubation was performed in OR conditions with difficult intubation equipment including fiberoptic bronchoscope, videolaryngscope, laryngeal mask airway and surgical tracheostomy ready for use. After pre-oxygenation for three minutes with 100% oxygen with the patient still in the sitting position, induction was performed with 250 mg propofol i.v. The patient was subsequently positioned supine. Face mask ventilation was successful with capnographic tracing and 100 mg succinylcholine was administered. Videolaryngoscopy was performed and a red, swollen epiglottitis with pin point lumen was seen. Intubation with a 5 mm microlarynx tube was successful at the first attempt. This is the first case describing intubation using videolaryngoscopy in an adult patient with acute epiglottitis. Videolaryngoscopy has already proven to be an excellent intubation device in normal and difficult airways. Direct laryngoscopy in patients with epiglottitis may be difficult due to the swelling and distortion of the airway. This case report shows that videolaryngoscopy is a good alternative intubation device option in adults with acute epiglottitis. Nevertheless, all other precautions (difficult airway trolley, surgical tracheostomy) need to be ready for immediate use.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, Catharina Hospital-Brabant Medical School, Eindhoven, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Vermelis
authors.forename: N
authors.initials: N
authors.lastname: Mateijsen
authors.forename: D
authors.initials: D
authors.lastname: Giebelen
authors.forename: V
authors.initials: V
authors.lastname: Meeusen
authors.forename: D T
authors.initials: DT
authors.lastname: Wong
authors.forename: A A J
authors.initials: AA
authors.lastname: van Zundert
mesh_terms: D000208:Acute Disease; D004826:Epiglottitis / Q000628:therapy*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D007828:Laryngoscopy / Q000379:methods*; D008875:Middle Aged; D014741:Video Recording