Anticipated Difficult Airway Management with Ambuscope in a Patient with Rhino-orbito-cerebral Mucormycosis

Abstract

Management of a difficult airway can be a nightmare for even an experienced anaesthesiologist. Video laryngoscopes have been mentioned in the difficult airway cart as a requisite equipment according to 2016 All India difficult airway guidelines. Ambuscope is a recently introduced flexible videoscope which is portable, light weight and single use device. This was a case of 25-year-old male who presented with loss of vision in both eyes and diffuse swelling of the face in the Ophthalmology Department. A diagnosis of post Coronavirus Disease-19 (COVID-19), Rhino-orbito-cerebral mucormycosis was made. Further patient was scheduled for emergency surgical debridement and bilateral orbital exentration under general anaesthesia. Airway assessment revealed mouth opening of one finger, Mallampati (MPG) score of 4, thyromental distance of 4.5 cm and a receding mandible with normal neck flexion and extension. Ambuscope™ 3 was employed for facilitating endotracheal intubation after anaesthesia induction. Ambuscope is a useful aid in confirming the position of endotracheal tubes and tracheostomy tubes in the operating room and intensive care unit. They are a disposable, convenient and practical alternative to fibreoptic bronchoscopes in patients of difficult airway. AmbuscopeTM 3 has tip movements with 150° up and 130° down. These unique features make this equipment user-friendly in anticipated and unanticipated difficult airway scenarios. Flexible endoscopes have carved a niche for themselves in the armamentarium of the anaesthesiologist airway cart to be equipped for any challenge.

Keywords

• challenging intubation
• emergency surgery
• video laryngoscope