When routine becomes the unexpected : a case report on an unexpected difficult intubation on an 49-year-old male patient for elective cholecystectomy / Keen Zherene T. Manalastas.

Includes bibliographical references.

Abstract: This is a case of 49-year-old male, hypertensive, non diabetic, with coronary artery disease-2 vessel disease s/p angioplasty with 3 stents, currently diagnosed with chronic calculous cholecystitis scheduled for laparoscopic cholecystectomy. Preoperatively, patient was assessed to have good mouth opening, Mallampati 1 and the thyromental distance was adequate at 6cms. None of the predictors for a difficult intubation were seen in the patient. Hence, anesthetic plan was to do smooth endotracheal intubation and achieve intubation with out too much stimulation of the patient's sympathetic system during direct laryngoscopy. However, during induction of general anesthesia and airway management, an unanticipated difficult intubation was encountered. The usual 5-minute procedure for securing the airway became an hour of multiple attempts and end with failed intubation, resulting to postponing the patient's surgery until after various work up to determine the cause of the difficulty in managing the patient's airway. Patient was rescheduled for open cholecystectomy with anesthetic plan to do an awake endotracheal intubation using the flexible fiberoptic bronchoscope. Correct endotracheal intubation was achieved, albeit with some difficulty, with aid of a flexible fiber optic bronchoscope.

Research - Department of Anesthesiology