Available online 19 May 2022

Preservation of spontaneous ventilation is the key for successful management of the difficult airway in an unfamiliar non-operating room scenario.

Awake direct laryngoscopy is a well-established alternative technique for an anticipated difficult airway. However, a high expertise in video laryngoscopy is crucial for a successful intubation. .

2% viscous lidocaine jelly can be used effectively for topical anesthesia during awake intubation.

Airway management in neonates with cystic hygroma is challenging. Preservation of spontaneous ventilation and inhalational induction with sevoflurane in 100% O2 may be the best option, but not feasible during an emergency where the extent of lesion and compression of airway structures were not known, particularly in a remote location due to risk of apnoea by sedation or intravenous induction of anaesthesia with compromised respiration.

We present a successful emergency airway management by awake intubation using a C-MAC® video laryngoscope in a 2-day old term neonate weighing 2.2 kg with 12×9 cm cystic hygroma extending up to the thoracic inlet.

Difficult airway

Neonate

Video laryngoscopy

Contrast-enhanced computed tomography

Neonatal intensive care unit

Percentage of glottic opening

© 2022 Published by Elsevier Ltd.