[Unexpectedly difficult intubation: fiberoptic endotracheal intubation with the laryngeal mask]

A 67-year old patient, scheduled for elective transvesical resection of the prostate gland, presented intubation problems. Fibreoptic assessment of the larynx revealed secretions as well as a swollen laryngeal mucosa; endotracheal intubation guided by the fibreoptic bronchoscope was not possible. After multiple attempts to intubate the trachea a laryngeal mask airway was inserted. Endotracheal intubation was completed by guidance of the fibreoptic bronchoscope via the laryngeal mask airway. After surgery the patient was transferred to an ICU and ventilated for one day. Fibreoptically controlled extubation was uneventful. Management of the unexpectedly difficult intubation is a challenge for every anaesthetist. The laryngeal mask airway, a relatively new device for airway protection, has proved to be beneficial in planned as well as in unexpectedly difficult endotracheal intubation. However, although the laryngeal mask airway may solve ventilation problems initially, prelaryngeal alterations present a contraindication for perioperative ventilation via the laryngeal mask airway. The fibreoptic intubation through the laryngeal mask airway is an important technique to consider in the "cannot intubate" situation.