Fiberoptic nasopharyngoscopy for evaluating a potentially difficult airway in a patient with elevated intracranial pressure.
A 62-year-old man with a left temporal lobe tumor was scheduled for a semiurgent craniotomy for tumor excision. Previously, the patient had a laryngeal carcinoma that was resected and treated with chemotherapy and radiotherapy and a history of laryngeal biopsy with awake fiberoptic intubation. Because a difficult airway was anticipated, awake fiberoptic nasopharyngoscopy of the airway was performed under topical anesthesia in the operating room. This revealed a narrow glottic opening with no supraglottic pathology or friable tissue. Based on these airway observations, we proceeded safely with intravenous induction and secured the airway in a controlled fashion, thereby minimizing the risk of increased intracranial pressure and catastrophic complications. Nasopharyngoscopy can be used safely to evaluate the upper airway to stratify airway management in patients with a history of head and neck cancer presenting for neurosurgical procedures in the setting of elevated intracranial pressure.
University of Mississippi Medical Center, Jackson, MS. Electronic address: lkurnutala@umc.edu.
Lakshmi N
LN
Kurnutala
The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: gurneet.sandhu@osumc.edu.
Gurneet
G
Sandhu
The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: Sergio.bergese@osumc.edu.
Sergio D
SD
Bergese
D058109:Airway Management / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005336:Fiber Optic Technology; D006801:Humans; D019586:Intracranial Hypertension / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery
Difficult airway; Fiberoptic nasopharyngoscopy; Laryngeal carcinoma