# When Our “Best” Isn’t Good Enough: Asleep Paralyzed Fiberoptic Intubation After a Failed Awake Fiberoptic at an Outside Hospital

## TL;DR

A 72-year-old woman required a complex intubation after previous attempts failed, leading to successful asleep, paralyzed intubation.

## Contribution

Presents a novel approach using asleep, paralyzed intubation after failed awake attempts in a high-risk patient.

## Key findings

- Awake fiberoptic intubation failed multiple times at an outside hospital.
- Asleep, paralyzed intubation using a combined video laryngoscope and fiberoptic method was successfully performed.
- The case highlights effective risk mitigation and decision-making in difficult airway management.

## Abstract

A 72-year-old, 127-cm, 53-kg female presented to our hospital after her surgery was canceled at an outside hospital due to multiple failed awake fiberoptic intubation attempts. She required a total abdominal hysterectomy, bilateral salpingectomy, and pelvic lymph node dissection for endometrial cancer. Given the prior failed awake attempts, we performed an asleep, paralyzed, combined video laryngoscope and fiberoptic oral intubation. The decision-making, actions, and risk mitigation provide an interesting case for discussion.