175 Regional anesthesia in difficult airway: is it foolish not to face it?

Background and Aims Difficult airway may represent a challenge in anesthesiologists’ clinical practice. In some cases regional anesthesia might be an option. Given a preformulated strategy for intubation, the right decision mainly depends on how confident the anesthesiologist is with the appropriate regional technique [1, 2]. We describe the case of an impossible to intubate patient, underwent surgical debridement of a neck ulcer under regional anesthesia. Methods Male 57 y.o. History of nasopharyngeal carcinoma, treated with radiotherapy. Post-actinic osteonecrosis of the jaw; scar tissue around muscles and vessels of the left side of the neck with consequent lock-jaw and cervical rigidity. Post-actinic infected lesion of the skin in the lateral, posterior and deltoid regions of the left side of the neck, scheduled for surgical debridement and vac-therapy. Awake tracheostomy was established as anesthetic management. The patient refused and asked for alternatives.Regional anesthesia was considered. Superficial or intermediate cervical plexus block were not feasible because of the scar tissue. Thus, to cover the area of debridement, a combination of a left ESP block at T2 level and a left deep cervical plexus block at C4 were performed. Awake, trans nasal fiberoptic intubation, was considered as preformulated strategy in case of emergency [3]. Results The surgical procedure was carried out uneventfully with the patient awake and cooperative. Conclusions Performing regional anesthesia in the difficult airways patients implies major knowledge of the relevant anatomy and techniques. Major skills in airways management are also required. Given these two conditions, it is not always foolish not to secure the airway.