Awake fiberoptic intubation (AFOI) in pediatric patients remains a continuous challenge for the anesthetists, and is considered more cumbersome procedure as compared to adult population. The coexistence of unstable cervical spine injuries, although rare, but complicates even more. Proper pre-planning, adequate sedation analgesia patient’s conscious cooperation are needed ensure success. We desc...

We report a case of acute upper airway obstruction caused by a rapidly expanding blood-filled bulla in the oropharynx (angina bullosa haemorrhagica), requiring tracheal intubation. The larynx could not be visualized by either awake fibreoptic laryngoscopy or direct laryngoscopy under anaesthesia. Surgical tracheostomy was therefore performed under general anaesthesia.

EDITOR: We read with great interest the paper by Slater and Bhatia [1]. In patients such as the one described in which surgery could represent a potential physical conflict for airway management, airway preoperative evaluation should be rigorous and precise, so as to allow planning of first-line strategy and of a ‘plan B’ in case of failure. In this case, no such information was available for t...

Tracheal intubation is older than the recognized history of general anesthesia itself. In the late 18th century, The Royal Humane Society of London used tracheal intubation for resuscitating the near-drowned. Approximately 100 years later, MacEwan (1) performed a digital tracheal intubation in an awake patient before a chloroform and air general endotracheal anesthetic for the resection of a to...