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Background <p>Unexpected difficult airway management, although rare, may occur after induction of anesthesia. In such cases, appropriate airway management is required to prevent life-threatening hypoxia.</p> Case presentation <p>In a 44-year-old woman without predicted difficult airway, after induction of general anesthesia, repeated attempts at tracheal intubation using videolaryngoscopes had failed, and ventilation using both a facemask and a supraglottic airway became difficult; the patient was awakened and the surgery cancelled. One week later, awake nasotracheal intubation using a flexible bronchoscope was attempted under high-flow nasal oxygenation. A clear view of the glottis was obtained by bronchoscopy and the trachea was intubated successfully without hypoxia.</p> Conclusions <p>In patients with unexpected difficult airway management, appropriate airway management (including awakening the patient) is required to prevent life-threatening hypoxia. High-flow nasal oxygenation would be useful for awake fiberoptic intubation, by providing a clear view of the glottis and by preventing hypoxia.</p>

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Unexpected difficult airway management and usefulness of high-flow nasal oxygenation for awake fiberoptic tracheal intubation: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月6日

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  • Takero Arai,
  • Ryosuke Osawa,
  • Takashi Asai

摘要

Background

Unexpected difficult airway management, although rare, may occur after induction of anesthesia. In such cases, appropriate airway management is required to prevent life-threatening hypoxia.

Case presentation

In a 44-year-old woman without predicted difficult airway, after induction of general anesthesia, repeated attempts at tracheal intubation using videolaryngoscopes had failed, and ventilation using both a facemask and a supraglottic airway became difficult; the patient was awakened and the surgery cancelled. One week later, awake nasotracheal intubation using a flexible bronchoscope was attempted under high-flow nasal oxygenation. A clear view of the glottis was obtained by bronchoscopy and the trachea was intubated successfully without hypoxia.

Conclusions

In patients with unexpected difficult airway management, appropriate airway management (including awakening the patient) is required to prevent life-threatening hypoxia. High-flow nasal oxygenation would be useful for awake fiberoptic intubation, by providing a clear view of the glottis and by preventing hypoxia.