Lateral Fiberoptic Intubation for a Morbidly Obese Patient w
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Fiberoptic bronchoscope intubation has been recognized as the appropriate solution to manage the difficult airway. Lateral position might be alternative method to mimic respiratory complication. The tracheal tube was successfully nasally intubated.

A 17-year-old man weighing 164.4 kg (height 184.6 cm body mass index of 48.2 kg m2) with ameloblastoma was scheduled for tumorectomy. Because of difficulty to maintain airway patency during induction of anesthesia due to severe obesity and location of tumor by evaluation of CT imaging, FOB-guided nasotracheal intubation following moderate sedation with midazolam, propofol and fentanyl while maintaining spontaneous breathing was performed. The patient was positioned in left lateral posture with coma position on the operation table. Moderate sedation was induced using propofol plus fentanyl following small dose of midazolam (2 mg) under standard monitoring vital signs. Propofol sedation was induced with intravenous propofol, administered via a Diprifusor (Astra Zeneca) target controlled infusion system.

The propofol target blood concentration was increased and kept constant between 1.5 and 2.0 g/ml to obtain an adequate level of sedation. Fentanil of 50 g was also induced for pain management. After obtaining of adequate sedative level, nasal cavity was disinfected with isodine and anesthetized with lidocaine gel. Thereafter, a well-lubricated 6 mm ID nasopharyngeal airway was inserted in the left nostril to confirm smooth passage and small cannula was inserted into nasal airway to give appropriate anesthesia into pharyngeal region. Subsequently, 7.5 mm ID nasotracheal tube was inserted into left nostril and FOB-guided intubation was successfully performed.