Adolescent child with cerebral palsy and a bunch of other comorbidities associated with that. You review the previous anesthetic record... Noted to be a difficult intubation on a previous surgery.
Proposed procedure is a prone spine case. What are the considerations for prone surgery, especially neurospine...? Induction? Emergence? How will you secure your tube?
The old anesthetic record noted they used a MAC #3, and an armoured tube. C-Mac STORZ in the room, and a lightwand just incase. DL produces grade 4 view... grade 3 with BURP. Used a bougie and intubated over that.
So, why re-invent the wheel? We did the exact same thing... Tube went in no problem. 5 hours into the case... we needed higher pressures to ventilate... something was off. Low tidal volumes. Turned the pressure up... was fine for a bit. Mind you the surgeons are being quite aggressive with the spine and moving things around. Then, the capnograph goes flat... You stop the surgeons and you place the patient supine. You've got every airway adjunct known to mankind available. Tube has fallen out.
You attempt DL... and there's so much edema. It's physically impossible to see anything...
What would be your initial sequence of management events/steps? (Yes, securing the airway is obvious... but how?
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A clinical case from a learner's perspective.
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