An Awake Flexible Scope Intubation for a Patient With Trisomy 21, COVID-19, and Ludwig's Angina.

For patients with known or suspected atlantoaxial instability, awake flexible scope intubation is often an attractive option for safely securing the airway. Due to the challenges of consent and cooperation, patients with trisomy 21 are generally considered to be poor candidates for this technique. However, in rare instances, such as the case of this patient with co-existing Ludwig's angina and COVID-19 pneumonia, the benefits of proceeding with an awake flexible scope intubation may outweigh the potential risks.