A Rapidly Enlarging Neck Mass: The Role of the Sitting Position in Fiberoptic Bronchoscopy for Difficult Intubation

Abstract

In Brief Difficult airway management is a dilemma for any anesthesiologist. Although practice guidelines and algorithms may help in such situations, the anesthesiologist's judgment and vigilance remain the primary means to save lives. In the following case, we encountered an acutely enlarging thyroid mass that was compromising the airway. This huge neck mass precluded tracheostomy under local anesthesia, and the patient could breathe only in the sitting position. Therefore, there were few safe strategies for airway management for general anesthesia. We reiterate the role of awake fiberoptic intubation in such circumstances. IMPLICATIONS: Management of the difficult airway presents a great dilemma for the anesthesiologist. This case report presents the management of a rapidly enlarging neck mass accompanied by respiratory distress. With the patient in the seated position, awake fiberoptic intubation was successful in securing the airway.