[Successful Awake Intubation with Airway Scope? for a Difficult Airway Patient with Enormous Angioma Protruding out of the Mouth].

A 48-year-old man (165 cm, 53 kg), was scheduled for an angioma resection. The tumor was so large that together with tongue, grew from the buccal region to the lower jaw and protruded out of the mouth. Mouth opening was only 2.5-finger-width. Expected as a case of difficult airway, we planned awake intubation using Airway Scope® (AWS) and gum-elastic bougie while maintaining spontaneous ventilation according to the difficult airway algorithm of American Society of Anes- thesiologists. Although fiberscope (FB) is a common choice for awake intubation, it requires proficient skills. In addition, as the distal end of endo-tracheal tube cannnot be visualized by FB, the angioma might be damaged during the intubation. Instead, AWS can visualize the tip of the tube without displacing oropha- ryngeal tissue and it is unlikely to damage the tumor because of a tube guide groove on the inner side of the AWS blade. We experienced successful awake intuba- tion with AWS for a patient with difficult airway due to an enormous angioma protruding out of the mouth.