[A Case of Penetrating Injury of the Neck in Which It Was Difficult to Secure the Airway].

A 76-year-old man sustained a penetrating neck injury caused by a metal rake following an accidental fall. On admission, he showed clear consciousness and no dyspnea. CT revealed that the tips of three prongs of the rake were located close to the vertebral artery and trachea. Cerebral angiography identified an injury to the vertebral artery, but no injury to the trachea or oropharynx. He was scheduled for vertebral artery embolization under general anesthesia. Since the neck must be stabilized, we chose to perform rapid sequence induction of general anesthesia with endotracheal intubation using a fiberoptic bronchoscope. Fiber-optic intubation was more difficult than had been expected, and the SpO2 decreased; therefore, mask ventilation was performed using only the jaw-thrust maneuver without neck extension. Although we attempted fiberoptic intubation 5 times, we were unable to obtain a view of the airway for tracheal intubation. We considered tracheostomy, but, finally, 35 min after anesthesia induction, we succeeded in endotracheal intubation using Airwayscope® without neck movement. The glottis was noted to have deviated from the midline. No severe hypoxemia occurred during the clinical course. Various airway management devices have been developed, and we should consider switching quickly to alternative methods.