[Awake fiberoptic intubation with Parker Flex-Tip tracheal tube in a patient with obesity, goiter, and laryngo-tracheal shift].

A 59-year-old woman with a body mass index of 30 and an edematous, tender goiter was scheduled for subtotal thyroidectomy. She had a history of dyspnea, cough, hoarseness, sleep disturbance in the supine position, difficulty in expelling sputum, and inability to rotate her neck to the left. Chest CT showed an adenomatous goiter, measuring 42 x 57 x 105 mm, with invasion into the mediastinal space, 17 mm right glottic shift, and 21 mm right tracheal shift. Because of her goiter and laryngo-tracheal shift, we anticipated a difficult intubation and ventilation. Awake fiberoptic intubation was selected for anesthesia induction, and was easily performed using a Parker Flex-Tip tracheal tube (Parker Medical, Highland Ranch, Colorado, USA), after intravenous injection of 200 microg of fentanyl, 8% lidocaine pump spray on the larynx with a direct laryngoscope, and 5 ml of 4% lidocaine spray on the vocal cords and trachea through a bronchoscope. The operation was completed successfully without any adverse events. Awake fiberoptic intubation with a Parker Flex-Tip tracheal tube is easily performed in a patient with a difficult airway due to obesity, goiter, and laryngo-tracheal shift.