NDLI: Successful awake intubation using Airtraq® in a low-resource setting for a patient with severe post-burn contractures

Content Provider	Springer Nature : BioMed Central
Author	Ponthus, Simon Odiakosa, Martina Gautier, Bertrand Dumont, Lionel
Abstract	Background In resource-limited settings, advanced airway management tools like fiberoptic bronchoscopes are often unavailable, creating challenges for managing difficult airways. We present the case of a 25-year-old male with post-burn contractures of the face, neck, and thorax in Nigeria, who had been repeatedly denied surgery due to the high risk of airway management complications. This case highlights how an awake intubation was safely performed using an Airtraq® laryngoscope, the only device available, as fiberoptic intubation was not an option. The patient had a mouth opening of 3.5 cm, a Mallampati score of 4, and no neck extension, making intubation challenging. Pre-procedural counseling was provided, and after explaining the risks, the patient gave informed consent. Case presentation Preoxygenation was performed, followed by topical anesthesia using lidocaine gargles and incremental spraying of lidocaine to the vocal cords via a feeding tube. The Airtraq® laryngoscope enabled glottic visualization despite limited neck mobility and challenging anatomy. Procedural challenges included managing aspiration during gargling, precise lidocaine application without advanced tools, and maintaining patient cooperation. The procedure was successfully completed, allowing surgery for contracture release. Conclusions This case emphasizes that safe awake intubation with an Airtraq® laryngoscope is feasible in low-resource environments when key principles—oxygenation, topical anesthesia, and careful procedural steps—are followed. The reuse of a single-use device like the Airtraq® laryngoscope extends its utility in resource-constrained settings, enabling complex airway management when alternatives are unavailable. The patient tolerated the procedure well and reported minimal discomfort. This experience underscores the critical importance of innovation, resourcefulness, and patient cooperation in managing difficult airways when standard tools are unavailable, offering valuable lessons for similar resource-constrained environments.
Related Links	https://bmcanesthesiol.biomedcentral.com/counter/pdf/10.1186/s12871-024-02887-x.pdf
Ending Page	6
Page Count	6
Starting Page	1
File Format	HTM / HTML
ISSN	14712253
DOI	10.1186/s12871-024-02887-x
Journal	BMC Anesthesiology
Issue Number	1
Volume Number	25
Language	English
Publisher	BioMed Central
Publisher Date	2025-01-07
Access Restriction	Open
Subject Keyword	Anesthesiology Internal Medicine Emergency Medicine Intensive Critical Care Medicine Awake intubation Low-resource setting Airtraq® laryngoscope Anticipated difficult airway Patient safety
Content Type	Text
Resource Type	Case study
Subject	Anesthesiology and Pain Medicine
Journal Impact Factor	2.3/2023
5-Year Journal Impact Factor	2.6/2023

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
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