Combination of C-MAC videolaryngoscope and fiber optic laryngoscope in a pediatric case with difficult airway: a case report

Background: Supraepiglottic masses are recognized as risk factors for unexpected failed tracheal intubation, and have been reported to cause difficult airway. In planning the management of anticipated difficult airways, the primary focus should be on ensuring adequate oxygenation and ventilation. This study presents a case of a 7-year-old male child with a difficult airway managed using combination C-MAC videolaryngoscope and fiber optic laryngoscope. Case Presentation: A 7-year-old male presented with complaints of uncomfortable sensation when swallowing for 2 months and progressively getting worse. He often snores and experiences periods of apnea during sleep. On examination, there was difficulty to intubate and supraglottic airway difficulty, based on Mallampati score 4, T1/T4 tonsil, and airway obstruction. During oxygenation and ventilation attempt using a face mask, the chest was expanded adequately with saturation maintained at 98-99%. Nasal intubation then performed with a fiber optic scope. The procedure was converted into a left tonsil biopsy followed by a tracheostomy. Conclusion: The efficient management option is to use technology such as a CMAC-video laryngoscope and fiber optic laryngoscope and combination in difficult airway management.