Management of Difficult Airway in Mentally Challenged Patient with TAScope and Fiberoptic Intubation: A Case Report

Managing a difficult airway is a very challenging task for practicing anaesthesiologists in day-to-day life. Addressing a difficult airway in patients with intellectual disabilities is even more challenging and requires a stepwise approach for management. The authors hereby report a case of a 26-year-old male patient, with intellectual disabilities who has a history of ankylosing spondylitis and was scheduled for an open gastrojejunostomy. The patient presented with a mouth opening of only 1.5 cm and grade IV extension, which restricted movements at the atlanto-occipital joint and resulted in a short neck. The most challenging aspect of the present case was the patient’s intellectual disability, which made it difficult to employ awake intubation techniques. Video laryngoscopy was not feasible due to the limited mouth opening and retrognathia. The authors planned for tracheal intubation using The Anaesthetist Society Scope (TAScope) and considered fiberoptic intubation as a second option. After a failed attempt at intubation under Intravenous (i.v.) anaesthesia with TAScope, fiberoptic intubation was successfully performed, albeit with difficulty. In conclusion, fiberoptic intubation is considered the gold standard for managing difficult airways.