When Our “Best” Isn’t Good Enough: Asleep Paralyzed Fiberoptic Intubation After a Failed Awake Fiberoptic at an Outside Hospital

A 72-year-old, 127-cm, 53-kg female presented to our hospital after her surgery was canceled at an outside hospital due to multiple failed awake fiberoptic intubation attempts. She required a total abdominal hysterectomy, bilateral salpingectomy, and pelvic lymph node dissection for endometrial cancer. Given the prior failed awake attempts, we performed an asleep, paralyzed, combined video laryngoscope and fiberoptic oral intubation. The decision-making, actions, and risk mitigation provide an interesting case for discussion.