Case 19: An Unusual Cause of Difficult Tracheal Intubation

Abstract

A 45-year-old, 80 kg Sikh man from India is admitted for repair of scapholunate dislocation. His past medical history and physical exam is unremarkable. He is classified as an ASA 1. He has got a full beard and speaks English very well. He requests a regional block, but unfortunately it proves to be inadequate for the surgery. General anesthesia is decided upon. Since it is not possible to accurate define the size of his thyroid-mental distance, a rapid sequence induction and intubation is decided upon. After preoxygenation, general anesthesia is induced with intravenous propofol 200 mg followed by succinylcholine 100 mg. Ventilation is easily accomplished by mask. At laryngoscopy the patient’s jaw is found not to be relaxed. Trismus is considered. The nerve stimulator shows loss of twitch. A Macintosh #3 laryngoscope blade is passed into the pharynx with great difficulty due to the very restricted mouth opening. Only the epiglottis is seen, but you manage to successfully place a #7 endotracheal tube in the trachea.