Time-efficient shared decision-making for airway management of a patient with intellectual disability and anticipated difficult airway: A case report

Physical classification was deemed American Society of Anesthesiologists Class 4E. Since the patient was predicted to have difficult airway access from syndromic sequelae [6], exam findings, and unstable cervical spine, we initially obtained informed consent for awake fiberoptic airway access. After positioning and removal of her cleft palate retainer, the airway exam demonstrated increased thyromental distance, mouth opening, and neck extension compared to her preoperative exam. Since the patient's mouth opening was deemed wide enough to accommodate a videoscope, we de-escalated to a slow IV propofol induction in divided doses of 40 mg to first ensure easy mask ventilation, then proceeded with neuromuscular blockade. [...]we demonstrate in this case report that in our emergent surgical case, a triangulated SHARE approach between our intellectually disabled patient, patient's family, and physician team was a crucial step in generating a safe, patient-centered anesthetic plan in anticipation of a difficult airway.Disclosures None.Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.