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PATIENT SAFETY

A Rapidly Enlarging Neck Mass: The Role of the Sitting Position in Fiberoptic Bronchoscopy for Difficult Intubation

Ali Dabbagh, MD^*, Naseraddin Mobasseri, MD^*, Hedayatollah Elyasi, MD^*, Babak Gharaei, MD^*, Mohammadreza Fathololumi, MD, Mahshid Ghasemi, MD^*, and Iman Bandarchi Chamkhale, MD^*

From the *Department of Anesthesiology, and Department of Otorhinolaryngology, Taleghani Hospital, Shahid Beheshti University, M.C. Tehran, Iran.

Address correspondence and reprint requests to Ali Dabbagh, MD, Department of Anesthesiology and Anesthesia Research Center, Shahid Beheshti University, M.C. Tehran, Iran. Address e-mail to alidabbagh{at}yahoo.com.

Abstract

Difficult airway management is a dilemma for any anesthesiologist. Although practice guidelines and algorithms may help in such situations, the anesthesiologist's judgment and vigilance remain the primary means to save lives. In the following case, we encountered an acutely enlarging thyroid mass that was compromising the airway. This huge neck mass precluded tracheostomy under local anesthesia, and the patient could breathe only in the sitting position. Therefore, there were few safe strategies for airway management for general anesthesia. We reiterate the role of awake fiberoptic intubation in such circumstances.