[Tracheal intubation with Pentax AWS Airway Scope after failed fiberoptic intubation and failed insertion of the intubating laryngeal mask airway].

Fiberoptic intubation is the most reliable method in patients with difficult airways, but it may be difficult in patients with restricted neck movement. The intubating laryngeal mask airway facilitates fiberoptic intubation, but its insertion may also be difficult in some circumstances. We experienced a case of successful tracheal intubation using the Pentax-AWS (Airway Scope) after failed fiberoptic intubation and failed insertion of the intubating laryngeal mask. A 74-year-old man who had undergone fixation of the cervical spine required reoperation. The magnetic resonance imaging showed a swelling in the posterior pharyngeal wall and glottic edema. The patient's neck was fixed by a cervical collar. After induction of anesthesia and neuromuscular blockade, fiberoptic intubation was attempted but failed, because it was impossible to advance the tip of the fiberscope beyond the epiglottis which was reclining to the swelling in the pharyngeal wall. Insertion of the laryngeal mask also failed, because the pharyngeal swelling prevented its insertion. Insertion of the Pentax-AWS was unaffected by the swelling and tracheal intubation was successful within 10 sec. We believe that the Pentax-AWS can be useful in the patient with restricted neck movement in whom both fiberoptic intubation and insertion of the laryngeal mask have failed.