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

Article Article scientifique Rapport de cas Successful awake intubation using Airtraq® in a low-resource setting for a patient with severe post-burn contractures eng 2025-01-07 2025-01-07 author Ponthus Simon Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, 1205, Switzerland. simon.ponthus@gmail.com.,2ND Chance Association, Geneva, Switzerland. simon.ponthus@gmail.com.,Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil, 4 Service d'anesthésiologie, Geneva, Switzerland. simon.ponthus@gmail.com. 692560 author Odiakosa Martina Department of Anaesthesia, National Orthopaedic Hospital, Enugu, Nigeria. author Gautier Bertrand Nicolas Pierre Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, 1205, Switzerland.,2ND Chance Association, Geneva, Switzerland. 953255 author Dumont Lionel Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, 1205, Switzerland.,2ND Chance Association, Geneva, Switzerland. 582454 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) 12 10.1186/s12871-024-02887-x 39773177 1471-2253 PMC11705717 https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-024-02887-x 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. Airtraq® laryngoscope Anticipated difficult airway Awake intubation Low-resource setting Patient safety Humans Male Adult Intubation, Intratracheal / methods Intubation, Intratracheal / instrumentation Contracture / surgery Burns / complications Laryngoscopes Nigeria Wakefulness Lidocaine / administration & dosage Anesthetics, Local / administration & dosage Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false BMC anesthesiology 25 1 52f8d7c3-8780-46b4-ba16-3bc9d2743501 Article (Published version) Public Article_scientifique_from_europePmc.pdf 890889 application/pdf CC BY-NC-ND-4.0 908c2b654cee97934257db9c9717ed28a665b5beb5f06346b6cd8686187af605 openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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Successful awake intubation using Airtraq® in a low-resource setting for a patient with severe post-burn contractures	BMC anesthesiology	2025	50	168

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