title: Successful intubation of a difficult airway due to a large obstructive vocal cord polyp augmented by the delivery of a transtracheal injection of local anaesthetic.
abstract: We describe a case of a very difficult intubation which was safely navigated through careful planning. Our patient presented initially with increasing hoarseness and shortness of breath over a 6-month period. This was investigated and the patient was found to have a large vocal cord mass and was referred for urgent microlaryngoscopy and vocal cord polypectomy. On the day of surgery the obstruction was noted and awake fiberoptic bronchoscopy was used with a remifentanil infusion. Given the mass was large and increased in size with expiration, the time frame to pass the tube was extremely short. We delivered a transtracheal injection of local anaesthesia. This approach allowed for safe passage of the endotracheal tube. In patients such as this it may be worth considering the use of a transtracheal injection in the first instance.
authors.affiliation: Department of Otorhinolaryngology, Abertawe Bro Morgannwg University Health Board, Swansea, UK.
authors.forename: Jayan
authors.initials: J
authors.lastname: George
authors.affiliation: Department of Anaesthetics, Singleton Hospital, Swansea, UK.
authors.forename: Jishar Abdul
authors.initials: JA
authors.lastname: Kader
authors.affiliation: Department of Anaesthetics, Singleton Hospital, Swansea, UK.
authors.forename: Sivasundari
authors.initials: S
authors.lastname: Arumugam
authors.affiliation: Department of Anaesthetics, Singleton Hospital, Swansea, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Murphy
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005336:Fiber Optic Technology; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D007818:Laryngeal Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery; D007828:Laryngoscopy; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D011127:Polyps / Q000150:complications / Q000473:pathology* / Q000601:surgery; D000077208:Remifentanil; D016896:Treatment Outcome; D014827:Vocal Cords / Q000473:pathology* / Q000601:surgery
chemical_list: D000779:Anesthetics, Local; D010880:Piperidines; D000077208:Remifentanil