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“Spray-as-you-go” medical technique for awake intubation using a combination of an epidural catheter and the OptiScope in a patient with Ludwig’s angina - A case report -
Anesth Pain Med 2018;13(3):336-40
Published online July 31, 2018
© 2018 The Korean Society of Anesthesiologists.

Da Jeong Nam1, Joung Goo Cho1 , Sang Hwa Kang1, and Soojeong Kang2
1Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang, 2Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
Correspondence to: Joung Goo Cho, M.D. Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea Tel: 82-31-900-0290 Fax: 82-31-900-0114 E-mail: ORCID
Received December 14, 2017; Revised February 1, 2018; Accepted February 2, 2018.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
A 73-year-old woman presented to the emergency department with submandibular pain and swelling. The patient was diagnosed to have Ludwig’s angina, and she was planned to undergo urgent incision and drainage under general anesthesia. However, her physical examination revealed severe diffuse swelling extending from the bilateral submandibular spaces to the submental space and further down to the neck. As our view was blocked by the patient’s neck swelling, we did not perform a regional anesthesia of the airway or a transtracheal block. Several non-invasive alternatives were considered. The “spray-as-you-go” technique was chosen, and it was performed using the OptiScope®. However, the OptiScope did not have a working channel or syringe adaptor for the administration of the local anesthetic solution. To solve this problem, we combined the OptiScope with a 27-G tunneled epidural catheter (100 cm) for the administration of lidocaine and this combination made the awake intubation successful.
Key Words : Awake intubation, Difficult intubation, Epidural catheter, Ludwig’s angina, OptiScope, Spray-as-you-go.

July 2018, 13 (3)
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