COMBINED USE OF VIDEOLARYNGOSCOPE AND BONFILS INTUBATION ENDOSCOPE AS RESCUE OPTION FOR DIFFICULT AIRWAY MANAGEMENT: A CASE REPORT/KOMBINIRANA UPORABA VIDEOLARINGOSKOPA I INTUBACIJSKOG ENDOSKOPA BONFILS KAO MOGUCNOST ZBRINJAVANJA OTEZANOGA DISNOG PUTA: PRIKAZ SLUCAJA

Dificult airway management poses a great challenge for clinicians, especially if it is unanticipated. Numerous guidelines and a wide array of devices constitute the anesthesiologist's armamentarium for managing the airway. When the use of individual devices fails, the use of combination techniques is advised. We present a case of difficult intubation in a 50-year-old male patient scheduled for aortic valve replacement. He had no prior history of difficult airway management, and no abnormalities were detected on preoperative airway assessment. Body mass index was 29 kg/m2. After the separate use of direct laryngoscopy, videolaryngoscopy and a BONFILS intubation endoscope (BIE) had failed, we resorted to a combination technique, combining videolaryngoscopy and BIE. While the videolaryngoscope provided the space needed for BIE and visual guidance through copious secretions, the BIE served as a stylet for endotracheal tube guidance, leading to successful intubation. Since the technique requires costly equipment, experience in handling it and at least two operators, it is more appropriate as a rescue measure than an elective procedure. Given the potentially disastrous outcomes of failed intubation, mastering advanced airway management techniques remains of vital importance, and the combination technique is one of them. Key words: Airway management; Anesthesia; Aortic valve; Body mass index; Intubation, intratracheal; Laryngoscopy; Optical devices Otezani disni put predstavlja velik izazov za klinicare, pogotovo ako je neocekivan. Anesteziolozima su na raspolaganju brojne smjernice i siroka paleta pomagala za zbrinjavanje disnoga puta, a kad pojedinacne tehnike zakazu, savjetuje se primjena kombiniranih tehnika. Predstavljamo slucaj otezane intubacije kod pedesetogodisnjeg muskarca kod kojega je planirana zamjena aortnog zalistka. Anamnezom nisu utvrdene ranije otezane intubacije. Prijeoperacijska procjena disnoga puta bila je bez osobitosti. Indeks tjelesne mase iznosio je 29 kg/[m.sup.2]. Nakon neuspjesne pojedinacne primjene direktne laringoskopije, videolaringoskopije i intubacijskog endoskopa BONFILS (BIE) primijenili smo kombiniranu tehniku kombinirajuci videolaringoskop i BIE. Dok smo videolaringoskopom osigurali potreban prostor za plasiranje BIE i poboljsali prikaz kroz obilan sekret, BIE nam je posluzio kao vodilica za endotrahealni tubus, sto je dovelo do uspjesne intubacije. Buduci da tehnika zahtijeva skupu opremu, iskustvo u njenoj primjeni te bare