A difficult neck
Description: a 53 years old male, scheduled for escissional surgery of a giant parotid tumor. Because of shame, the patient left it growing until becoming giant and necrotic.
CT scan showed vascular infiltration and severe tracheal deviation; the patient complained difficulty during night respiration. Surgery was planned and informed consent was obtained for..
Airway management: … awake fiberoptic nasal intubation. Generous local anaesthesia was performed, and atropine + prometazine was given intramuscularly 30 minutes before manoeuvres.
Supplementary oxygen was given via a small nasal catheter.
Intubation was very difficult because of tracheal deviation and partial landmarks alteration; a 7 mm ID cuffed ET was finally inserted and general anaesthesia was then induced.
4 hours after the patient was extubated on an airway exchange catheter left in place for 1 hour after extubation.
The big issue was need for urgent reintubation the day after, because of sudden and massive bleeding from a laceration in carotid artery..