# Management of Difficult Airway in a Coronary Artery Bypass Graft Patient With Limited Oral Access

## TL;DR

This paper discusses the successful management of a difficult airway in a patient with limited oral access undergoing heart surgery.

## Contribution

The paper presents a novel case study on managing a difficult airway in a CABG patient with altered jaw anatomy.

## Key findings

- Awake intranasal fiberoptic intubation was successfully used due to limited oral access.
- The patient underwent CABG surgery without adverse outcomes.
- Proper pre-induction preparation and hemodynamic monitoring were critical for success.

## Abstract

Management of difficult airways is a recognized challenge in anesthesia and can be further complicated by altered anatomy. We present a case of a 56-year-old male with a history of a mandibular jaw tumor resection requiring coronary artery bypass graft (CABG) surgery. The altered anatomy due to the patient’s jaw resection required awake intranasal fiberoptic intubation as there was limited oral access. Our discussion focuses specifically on adequate pre-induction preparation, hemodynamic monitoring, and pharmacological agents used for intubation. Despite the complexity of the case, our patient was successfully induced and intubated without any adverse outcomes. He ultimately underwent a two-vessel CABG with uneventful extubation.