Difficult airway in patient with multiple face skin tumours

Aim – A difficult airway can be a serious anesthesiological problem even for a very experienced
anesthesiologist. The impossible airway management is a life-threatening condition for the
patient and very stressful for the anesthesiologist. The purpose of this paper is to show the
importance of the preoperative assessment that anticipate and avoid the predicted difficulties
and complications.
Materials and methods – Case of 69 years old man, admitted to hospital for surgical treatment
on multiple face skin carcinomas. The locations of the tumours, on the nose, buccal and mouth
region, the patient body constitution, such as his medical history, predicted the difficult face mask
ventilation and intubation. In the patient medical history was established that the patient had
polytrauma 3 years ago, when the cervical spine was injured and tracheostomy was performed.
The patient had poor C – spine movement, especially upper extension, as result as old trauma.
His BMI 30 kg/m2, poor dentition, Mallampati class 4 and thyromental distance – 4 cm were
additional difficulties. On CT scan, tracheal stenosis was not detected. In the operating room, after
the preoxygenation, the patient was sedated with midazolam, fentanyl and propofol. The face
mask ventilation was performed easy, using oropharyngeal airway device, suxamethonium was
administrated and using a videolaryngoscope was intubated with flexible endotracheal tube.
After the surgery, the patient was extubated in the operating room and transferred in intensive
care unit.
Conclusion – Although the difficult airway is the most important cause of anesthesia – related
mortality, this undesirable condition can be successfully avoided with adequate preoperative
assessment and planning, as well as the use of advanced equipment that make the procedure
easier and safer for the patient and the anesthesiologist.