• Marina Kljaković-Gašpić Batinjan, Igor Vlatković, Karlo Vidović, Renata Curić Radivojević, and Željko Čolak.
• Department of Anesthesiology, Resuscitation, Intensive Medicine and Pain Therapy, Zagreb University Hospital Center, Zagreb, Croatia.
• Acta Clin Croat. 2023 Apr 1; 62 (Suppl1): 149153149-153.

AbstractDifficult airway management poses a great challenge for clinicians, especially if it is unanticipated. Numerous guidelines and a wide array of devices constitute the anesthesiologist's armamentarium for managing the airway. When the use of individual devices fails, the use of combination techniques is advised. We present a case of difficult intubation in a 50-year-old male patient scheduled for aortic valve replacement. He had no prior history of difficult airway management, and no abnormalities were detected on preoperative airway assessment. Body mass index was 29 kg/m2. After the separate use of direct laryngoscopy, videolaryngoscopy and a BONFILS intubation endoscope (BIE) had failed, we resorted to a combination technique, combining videolaryngoscopy and BIE. While the videolaryngoscope provided the space needed for BIE and visual guidance through copious secretions, the BIE served as a stylet for endotracheal tube guidance, leading to successful intubation. Since the technique requires costly equipment, experience in handling it and at least two operators, it is more appropriate as a rescue measure than an elective procedure. Given the potentially disastrous outcomes of failed intubation, mastering advanced airway management techniques remains of vital importance, and the combination technique is one of them.Sestre Milosrdnice University Hospital.

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