Airway Management in an Anatomically and Physiologically Difficult Airway.

A "difficult airway" should be suspected in patients with any anatomical or physiologic abnormality that might result in the loss of the airway or significant cardiopulmonary compromise upon induction of general anesthesia. Historically, an awake intubation has often been the preferred approach for airway management in these patients. Here we describe a case in which an awake intubation was safely performed in a patient with both anatomical (i.e., laryngeal mass) and physiologic (i.e., pulmonary hypertension) abnormalities. Oxygenation, airway patency, and spontaneous breathing were well maintained with successful intubation on the first attempt. We recommend that the patient's physiologic state should always be considered in airway management planning.