Management Of The Vocal Cord Biopsy In A Patient With Difficult Surgical Access (Preview)

We report complex airway management in a 50 year old female patient who was scheduled for an elective microlaryngoscopy for hoarseness. Her only comorbidity was hypertension for which she took candesartan (angiotensin-II receptor blocker) and lercanidipine (a calcium channel blocker). Baseline labs and ECG were normal. The airway exam revealed a Mallampati 2 class airway, limited mandibular protrusion (Grade C), mouth opening of > 3cm and thyromental distance of over 6 cm. There was no loose or false dentition, with 3 crowns present (including the incisors).

Baseline observations in the anaesthetic room were all within normal range and anaesthesia was induced uneventfully with Fentanyl 100 mcg IV and Propofol 300 mg IV; muscle relaxation was facilitated with Rocuronium 50 mg IV. She was easy to bag-mask ventilate (BMV), and anaesthesia was maintained with sevoflurane, oxygen and air. Laryngoscopy was performed using an AP Advance™ video laryngoscope with a size 3 blade, which revealed a Grade 3 view. Laryngoscopy was attempted again with the size 4 blade, but the view could not be improved despite head elevation and cricoid pressure. The blade was then changed to ......