Utilization of Preoperative Endoscopic Airway Examination Guiding Difficult Airway Management in an Unknown Cause of...

Assessing the extent of pathology in difficult airways and choosing the optimal airway management strategy in such cases can be a challenge for clinicians. Preoperative endoscopic airway examination (PEAE) is helpful in evaluating a challenging airway and formulating an airway plan in stable patients. A 52-year-old male scheduled for esophagogastroduodenoscopy (EGD) and biopsy presented with dysphagia, aphonia, mucositis, mucosal bleeding, and impaired mouth opening from pain. We were unable to complete the airway exam and were concerned about possible airway edema. PEAE was easily performed in preoperative holding area, airway was significant for erythema with no significant edema, no active bleeding, and mucosa had cobblestone-like appearance. With this information, we were confident to undergo EGD and biopsy with native airway under total intravenous anesthesia (TIVA). The patient was later diagnosed with diffuse large B cell non-Hodgkins lymphoma and paraneoplastic pemphigus.