International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 4, Issue 7 | Case Report | Open Access DOI
Yassin Abedelraheem*
Senior House Officer Anesthesia-Tallaght University Hospital, Dublin
*Correspondence to: Yassin Abedelraheem
Fulltext PDFDifficult airway management remains one of the most critical safety concerns in anesthesia. Although structured preoperative airway assessment can identify many high-risk patients, difficult laryngoscopy or intubation may still occur in patients with apparently reassuring airway features. This case report describes an unexpected difficult airway encountered during elective general anesthesia and highlights the importance of preparation, early escalation, video laryngoscopy, oxygenation-first decision-making, and post-event airway documentation. A 40 year old male patient presented for elective abdominal surgery under general anesthesia. Preoperative airway examination was reassuring, with Mallampati class II, full neck extension, and no history of difficult intubation, obstructive sleep apnea, facial trauma, or prior airway surgery. After standard monitoring, preoxygenation, induction, and neuromuscular blockade, direct laryngoscopy revealed a Cormack-Lehane grade III view despite optimal positioning and external laryngeal manipulation. Mask ventilation remained adequate. A second attempt using video laryngoscopy improved visualization, but endotracheal tube advancement was difficult because of an anterior larynx and limited glottic access. A bougie-assisted technique allowed successful tracheal intubation. Correct placement was confirmed with continuous waveform capnography and bilateral chest auscultation. The surgery proceeded uneventfully. The patient was extubated awake after meeting standard criteria and had no postoperative airway complications. This case emphasizes that a normal airway examination does not eliminate the risk of difficult intubation. Anesthesia teams should maintain a prepared difficult-airway plan for every general anesthetic, prioritize oxygenation, limit repeated attempts, escalate early to advanced airway devices, and clearly document the event for future anesthetics.
Difficult airway; Unexpected difficult intubation; Video laryngoscopy; Bougie; Airway management; Anesthesia; Case report
Yassin Abedelraheem. Unexpected Difficult Airway During Elective General Anesthesia in a Patient With Reassuring Preoperative Airway Assessment: A Case Report. Int Clinc Med Case Rep Jour. 2025;4(7):1-6.