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Case report demonstrates successful airway management using directed nebulization in a patient with complex anatomy, suggesting new approaches to intubation.
Awake flexible bronchoscopic (FB) nasotracheal intubation is recommended for anticipated difficult airways, but its success depends on effective airway topicalization. We report a case of a patient with a severely distorted upper airway due to a maxillary tumor, where conventional topicalization techniques were impractical. Directed nasal nebulization of lidocaine using an uncuffed endotracheal tube (ETT) as a conduit, supplemented with spray-as-you-go (SAYGO) anesthesia and dexmedetomidine sedation, facilitated successful awake intubation. This case demonstrates the applicability of directed nasal nebulization in complex airway anatomy when alternative topicalization strategies are limited.
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Sundaram et al. (2026) studied this question.
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