Management of a difficult-to-ventilate and difficult-to-intubate airway: Anesthetists' nightmare

The American Society of Anesthesiologists standard monitors were placed to ensure oxygenation during the procedure; a suction catheter attached to the oxygen source with a flow of 10 L/min was advanced toward the glottic opening through the transorbital route. Fiberoptic bronchoscope was passed through the right side of the oral cavity, and advanced till carina (spray as you go), followed by railroading-cuffed endotracheal tube (ETT) of size 8.0 mm. The position of the ETT was confirmed by checking bilateral equal air entry and capnography. Intraoperative period (2 h) was uneventful; the patient was extubated over a tube exchange catheter, and postoperative course went uneventful [Figure 1]d.{Figure 1} In patients with huge maxillofacial defect, the airway can be secured by blind nasal, oral, transorbital, AFOI, or surgical airways.