Awake Fiberoptic-Guided Intubation in Difficult Airway: A Case Report

Introduction: The management of the difficult airway remains one of the main challenges in anesthesiology due to the risk of hypoxia, neurological injury, and death associated with inadequate airway control. Awake fiberoptic-guided intubation is a safe and effective strategy in patients with anticipated difficult airway, as it allows securing the airway prior to anesthetic induction while maintaining spontaneous ventilation. Case Report: We present the case of a 74-year-old female with a history of left breast cancer previously treated with breast-conserving surgery, radiotherapy, and hormone therapy. Six years later, she was scheduled for wide resection of a left shoulder tumor with axillary lymphadenectomy due to basal cell carcinoma associated with metastatic axillary lymph node. During the preanesthetic evaluation, multiple predictors of difficult airway were identified, including short neck with limited cervical extension, 2 cm mouth opening, Mallampati IV classification, and a sternomental distance of 12 cm. Therefore, awake fiberoptic-guided intubation was planned. Supplemental oxygen was administered along with sedation using dexmedetomidine and fentanyl, in addition to nebulization and regional airway block with 2% lidocaine. Intubation was successfully performed using a fiberoptic bronchoscope (LF-2 model) without complications, followed by balanced general anesthesia for the surgical procedure. Intraoperative and immediate postoperative courses were favorable, with no respiratory or hemodynamic adverse events. Conclusion: Awake fiberoptic-guided intubation is a safe and effective technique in patients with anticipated difficult airway. This case highlights the importance of careful preoperative evaluation, anticipatory planning, and maintaining proficiency in advanced airway management techniques to improve patient safety.