Unanticipated cannot intubate situation due to difficult mouth opening

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Emergency Medicine

Background:

• A 76-year-old female patient, classified as American Society of Anesthetists risk Class IV E, was scheduled for an emergency laparotomy.
• Preoperatively, her temporomandibular joint function appeared normal, with no prior history of joint issues.

Observation:

• During rapid sequence induction and muscle relaxation with rocuronium, the anesthesiologist encountered an abrupt onset of lock-jaw, preventing oral intubation.
• Ventilation was initially managed with a nasopharyngeal airway, but the patient experienced progressive desaturation.

Findings:

• An emergency tracheostomy was performed due to the intractable airway obstruction.
• Despite interventions, the patient experienced cardiac arrest and could not be resuscitated.

Implications:

• This case underscores the critical and potentially catastrophic implications of unanticipated difficult airways, specifically lock-jaw, in anesthetic management.
• It emphasizes the need for preparedness and advanced airway management strategies when facing rare complications during surgical procedures.
• The event highlights the severe risks associated with airway management challenges, even in seemingly low-risk situations.