[Successful fiberoptic tracheal intubation guided by Airwayscope with a thin Intlock blade in a patient with severe...

We present a case of anticipated difficult airway with severe rheumatoid arthritis in which intubation with fiberoptic bronchoscope (FOB) assisted by Pentax-AWS Airwayscope with the thin Intlock (AWS T) was effective. A 69-year-old woman was scheduled to undergo laparoscopic cholecystectomy for acute cholecystitis in a previous hospital. Tracheal intubation with Glidescope or nasal intubation was unsuccessful and abandoned due to mucosal injury and bleeding. Ventilation via several supraglottic airway devices was unsatisfactory, while mask ventilation was easy after induction of anesthesia. She was referred to our hospital for application of veno-arterial extracorporeal life support in case of 'cannot ventilate and cannot intubate'. We planned to perform tracheal intubation preserving spontaneous breathing under intravenous administration of dexmedetomidine and fentanyl. We could visualize the epiglottis, but could not set the target mark to the invisible glottis with AWS-T. Finally, we could accomplish uneventful tracheal intubation with FOB along with the Intlock's guides of AWS-T.