Use of sole-agent ketamine sedation to facilitate laryngoscopy and foreign body removal in acute supraglottic airway obstruction.

A 78-year-old man presented with stridor and dysphonia after choking at home. He deteriorated, with respiratory distress and an oxygen saturation of 55% despite oxygen via a non-rebreather mask. Flexible nasendoscopy demonstrated a food bolus between the epiglottis and glottis. The team judged apnoea and assisted positive-pressure ventilation before extraction to be hazardous, while deterioration and limited cooperation made an awake technique impracticable. Sole-agent ketamine sedation facilitated videolaryngoscopy with clinically observed spontaneous breathing; the bolus, a slice of carrot, was removed using Magill forceps. Rocuronium was then administered and an attempt at tracheal intubation prior to its onset was unsuccessful. As rocuronium took effect, the laryngoscopic view improved and copious blood-stained tracheal fluid appeared. Following suction, the trachea was intubated. Negative-pressure pulmonary oedema was suspected. His lungs were ventilated for 48 h, and he was subsequently discharged home without sequelae. The case illustrates staged foreign body removal and subsequent tracheal intubation, with preparation for neuromuscular blockade and airway rescue. In this patient, ketamine facilitated laryngoscopy and foreign body removal while spontaneous breathing was clinically observed.