Background: Burning victims in countries with less access to specialized medical care are often exposed to avoidable sequelae. These sequelae include post-burn scars and scar contractures, with a huge impact on the patient daily life. When these patients are proposed for any anesthesia procedure, pre-anesthetique assesment is essential.
Case report: 38 year old woman evacuated from São Tomé e Príncipe 15 months after a severe burning accident with gasoline, was proposed for a cervical scar contraction repair. The procedure was to be done under general anesthesia. The patient was evaluated at the preanesthestic assessment one month prior to the surgery. The main problem encountered was a difficult airway. Her cervical contracture scarring impaired neck mobility, extension and obliged her to a hyperflexion position, as see in the pictures1. Intubation using a laryngoscope was impossibe, and glidescope was also not helpful. Tracheotomy was also impractical, because of impossible access to the trachea. What to do?
Discussion:  Difficult airway has always been an anesthesiologist's challenge. In this case, the patient had not only a previsible difficult intubation, but also external distorion of the airway impeded ventilation. Furthermore there was no possiblity of a surgical airway: an awake nasotracheal fibroscopic intubation was the only option. Fibroscopic intubation was planned in advance and successful.
References: 1Jasper AO. Anaesthetic management of post-burn contractures, a recurrent challenge from oil pipeline vandalization in Nigeria: a case report. Cases Journal. 2009;2:9141. doi:10.1186/1757-1626-2-9141.
Learning points: Preparing for anesthesia is an essential step on our daily activity. Prevention is the keyword to avoid intraoperative complications, mortality and morbidity.

Preparing for a difficult airway in burning victim - a shocking case report