Translaryngeal guided intubation in a patient with raised intracranial pressure

A 60-year old man with intracranial space occupying lesion, presented with difficulty in intubation at induction of anaesthesia. Several attempts at direct tracheal intubation were made until the airway was finally secured. Though the brain was slack, the tumour could not be located at this operation. He presented for re-operation with worse signs of raised intracranial pressure which may accompany repeated attempts at intubation, a planned translaryngeal guided intubation was employed to secure the airway. Where fibreoptic laryngoscope is unavailable and difficult tracheal intubation is envisaged, translaryngeal guided intubation may save time and reduce morbidity of prolonged and repeated attempts at tracheal intubation.