ABSTRACT : Endotracheal intubation can be challenging in ICU because of factors like inadequate patient positioning, preparedness, etc. Earlier, video laryngoscope was shown to be useful in perioperative difficult airway management. We would like here to present about the successful airway management of a patient in ICU, with massive goiter with hypoxic respiratory failure, using a C-Mac video laryngoscope.

METHODS : HISTORY AND EXAMINATION:

A 78 yr old obese female, a known hypothyroid was admitted with complaints of right sided weakness and breathing difficulty for last two days. She was transferred to ICU in view of hypoxic respiratory failure. On inspection, there was an obvious massive swelling in the front of the neck. CT scan neck showed a 9x6x6 cm mass arising from the right lobe of thyroid causing significant mass effect on oropharynx, larynx and trachea with airway narrowing.

AIRWAY MANAGEMENT:

After preoxygenation, patient was induced with Inj fentanyl 200 mcg IV and Injetomidate 8 mg IV. Endrotracheal intubation was attempted with direct laryngoscopy with Macintosh blade, using a Frova intubating introducer. This attempt failed because of poor laryngeal view of Cormack-Lehanegrade 4. Subsequent attempt with C-Mac video laryngoscope yielded a C-L grade 2 laryngeal view and was successfully intubated with 6.5 mm ID Flexometallic endotracheal tube.

RESULTS : not applicable

CONCLUSIONS :We conclude that video laryngoscope is essential in managing difficult airways encountered outside operating room.