Successful Blind Digital Intubation with a Bougie Introducer in a Patient with an Unexpected Difficult Airway

Abstract

A critical aspect of providing safe general anesthesia is the preoperative assessment of the patient's airway. Adequate ventilation and oxygenation are essential for the well-being of the patient. Numerous assessment tools and airway management algorithms have been published to help the anesthesia provider make safe decisions and protect the patient (1–6). Despite careful evaluation of the airway preoperatively, the provider can be presented with an unanticipated difficult airway to manage. Therefore, after induction of anesthesia and before a paralytic muscle relaxant medication is administered and a potential “point of no return” has been reached, the prudent practitioner again assesses the airway. The airway is tested to ensure that bag-mask ventilation (BMV) is easily attainable before a muscle relaxant is administered. If it is not possible to utilize BMV, the patient is awakened and a secure airway obtained under local anesthesia and sedation with the patient breathing spontaneously. This case report describes a patient who presented with minimal indicators of a difficult intubation and good BMV after induction of anesthesia. Difficulties were then encountered. Many maneuvers have been described to obtain a successful intubation of the trachea in this situation (7). This report describes another novel technique that might be applied.