Successful tracheal intubation through the air-Q intubating laryngeal airway in a patient with severe pharyngeal edema

A 68-year-old man was diagnosed with severe pharyngeal edema after neck lymph node dissection for cancer of the external ear canal. He was scheduled for an emergency tracheotomy, but preoperative fiberoptic laryngoscopy revealed airway and glottic obstruction due to severe pharyngeal edema. As difficult mask ventilation and tracheal intubation were anticipated, intubation under spontaneous ventilation was performed to avoid a "can't ventilate, can't intubate" situation. The first attempt to intubate the patient using the Pentax-AWS Airwayscope with a thin Intlock resulted in failure due to hindered visualization of the glottis. Therefore, a size 3.5 air-Q intubating laryngeal airway was inserted using a bronchofiberscope to perform tracheal intubation through a laryngeal mask. Successful tracheal intubation was achieved while maintaining spontaneous ventilation. The air-Q intubating laryngeal airway can be useful in the setting of anticipated difficult mask ventilation and tracheal intubation, as in the case of severe pharyngeal edema.