A 67-year-old man required an urgent laparotomy for a bleeding gastric ulcer. He had undergone three upper gastrointestinal endoscopies over five days since admission to hospital. Tracheal intubation was unexpectedly difficult due to marked supraglottic oedema as well as unfavourable upper airway anatomy. A fibreoptic intubation through a laryngeal mask airway was performed with difficulty. The management of this case of difficult intubation following repeated endoscopy is presented.
TonnerP.H., ScholzJ., PothmannW.Unexpectedly difficult intubation: fiberoptic endotracheal intubation with the laryngeal mask. Anasthesiologie1995; 30: 192–195.
2.
British Society of Gastroenterology Endoscopy Committee. Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut2002; 51: iv1–iv6.
3.
HeierT., FeinerJ.R., LinJ., BrownR., CaldwellJ.E.Hemoglobin desaturation after succinylcholine-induced apnea: a study of the recovery of spontaneous ventilation in healthy volunteers. Anesthesiology2001; 94: 754–759.
4.
BenumofJ.L., DaggR., BenumofR.Critical hemoglobin desatu-ration will occur before return to an unparalyzed state following 1mg/kg intravenous succinylcholine. Anesthesiology1997; 87: 979–982.
5.
ChartersP., O'SullivanE.The ‘dedicated airway’: a review of the concept and an update of current practice. Anaesthesia1999; 54: 778–786.
6.
JonathanL., BenumofM.D.Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology1996; 84: 686–699.
7.
AsaiT., BarclayK., PowerI., VaughanR.S.Cricoid pressure impedes placement of the laryngeal mask airway. Br J Anaesth1995; 74: 521–525.
8.
AoyamaK., YasunagaE., TakenakaI., KadoyaT., SataT., ShigematsuA.Positive pressure ventilation during fibreoptic intubation: comparison of the laryngeal mask airway, intubating laryngeal mask and endoscopy mask techniques. Br J Anaesth2002; 88: 246–254.