Pulmonary aspiration during anesthetic induction in a patient with a history of distal gastrectomy

: We experienced a case of pulmonary aspiration during anesthetic induction. Posterior laminoplasty was scheduled for a 59-year-old man with ossification of posterior longitudinal ligament, who had undergone distal gastrectomy 30 years ago. Anesthesia was induced with intravenous administration of midazolam and fentanyl, and inhalation of sevoflurane was gradually increased to 7% in oxygen under spontaneous breathing, since difficult intubation had been predicted due to poor neck mobility However, the patient vomited during laryngoscopy. Orotracheal intubation was performed with a fiberscope and the excreta was suctioned through the endotracheal tube. The patient was admitted to the ICU after taking chest X-ray and the operation was postponed for one month. At the second attempt, awake intubation was planned for the patient under sedation with dexmedetomidine. Food intake and drinking were restricted for the patient from the previous night. After administration of fentanyl, continuous administration of intravenous dexmedetomidine was started, and 2% lidocaine viscous solution was gargled. Endotracheal intubation was successfully performed using AirWay Scope without pulmonary aspiration, and midazolam was administered intravenously. Surgery was completed without any troubles, and the patient was extubated fully awake.