Capnography-guided blind nasal intubation under conscious sedation for airway management in a plunging ranula

A 22-year man with human immunodeficiency virus ((HIV)-positive status for excision of huge, painless swelling in the floor of the mouth was admitted. The swelling occupied the anterior part of the neck; intraoral part of the swelling was extended downward and anteriorly in the sublingual space deviating the tongue. Fiberoptic intubation has helped immensely in handling many difficult airway scenarios. In low-resource setting, often multiple-use fiberoptic is used due to which fear of risk of cross-contamination from blood, secretions, or suctioning is there. The challenges were to secure the airway with difficult bag-mask ventilation, difficult laryngoscopy, difficult video-laryngoscopy and nonavailability of single-use fiberoptic bronchoscope and to avoid tracheostomy. This case report illustrates how blind nasal intubation (BNI) under conscious sedation can help avoid tracheostomy or retrograde endotracheal intubation.