Clinical case 067: awake intubation procrastination.
September 27, 2012
Had an interesting case this week. A middle-aged woman who had developed a slowly growing submandibular swelling over a week and was now not r esponding to intravenous ABs. US revealed an abscess in her salivary gland, no obvious stone. So I was asked to see her for pre-anesthetic assessment, with a view to draining his collection later in the day.
Basically she had a few comorbidities, but had had a GA for a gynae procedure 3 months ago with an easy, grade 1 intubation.
BUT today she had good going trismus, her mouth opening was about 1.5 cm and the swelling was firm, extending under her jaw just across the midline in he floor of the mouth. Her trachea and thyroid cartilage were palpable and not displaced.
She was reasonable calm and understanding of the situation.
So after NAP4 I am keen to consider an awake / fibre optic technique for this type of patient – though as a rural GP this is something I see very infrequently.
So here is my questions to you all.
Q1: Would you opt for an awake technique in his scenario?
Q2: if she refused, did not tolerate or you failed, what is the next best plan?
Q3: airway topicalisation – any good tricks, kit or videos to share?
Let me know, will post a summary of the comments and any resources I come across in a few days – going beaching in remote NW for a few days.
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact