Document resource
Background and Aims Airway management skills are a critical component of anesthetic practice, particularly in unexpected difficult airways that standard assessments may overlook. Such cases elevate risks during intubation, ventilation and extubation, requiring specialized skills for improved patient outcomes. We present a case of a 56-year-old man scheduled for elective robotic radical prostatectomy and bilateral lymphadenectomy due to prostate cancer.Methods Despite a Mallampati score II and a thyromental distance of less than 6 cm, intubation was challenging due to an omega-shaped epiglottis and an anterior glottis. Four intubation attempts were needed, including the use of video laryngoscopy and a bougie, as well as patient repositioning to improve airway management, leading to a successful orotracheal intubation. The patient experienced only a brief desaturation although successful facemask ventilation was maintained between intubation attempts. He remained hemodynamically stable throughout the procedure and neuromuscular blockade was reversed at the end. We performed a periglottic anesthesia with 10 mL of 0.2% lidocaine and a tube exchanger catheter was placed before extubation. After extubation, the patient was drowsy but easily arousable, with intact cough and swallowing reflexes, and was transferred to the PACU for ongoing monitoring. The patient was briefed postoperatively, including future anesthetic considerations, with proper documentation provided.Results This case exposes the importance of a well-planned extubation strategy and highlights the potential benefits of topical airway anesthesia in enhancing patient outcomes. Research suggests that topical airway anesthesia can reduce complications during the immediate post-extubation phase by minimizing cough reflex and laryngeal injury. This results in smoother recovery, reduced agitation, and improved hemodynamic stability by alleviating stress responses.Conclusions While topical airway anesthesia is an effective tool for enhancing comfort and safety post-extubation, its use must be tailored to individual patient needs. Furthermore, there is a pressing need to establish algorithms and strategies for extubation after difficult airway intubation.