General Anesthesia for a Patient with a Difficult Airway and a Full Stomach

A 26-yr-old female (American Society of Anesthesiologists physical status 2E), weight 124 kg, height 5′6″, is scheduled for an emergency appendectomy. She has a class 3 airway, but tells you that she has a previous history of a traumatic and difficult endotracheal intubation. She is otherwise healthy and takes no medication. She refuses a regional block, as she has back problems. You decide on a fiberoptic intubation, but you are fully aware that topical anesthesia and sedation must be kept to a minimum in an attempt to maintain the protective laryngeal reflexes and decrease the likelihood of gastric aspiration. What approach would you adopt for this case, based on anatomical and physiological observations?