Securing the Airway Amidst Thyroid Swelling: A Case of Acute Stridor Managed with Awake Video Laryngoscopy Technique in Lateral Decubitus Position

Summary: This case report highlights the management of a 53-year-old female with acute stridor and respiratory distress, attributed to a large thyroid mass. In the emergency department at AIIMS Bhopal, an awake video laryngoscopy technique was used to secure the airway, positioning the patient in the right lateral decubitus after topical nebulization with 4% lidocaine. This approach allowed for safe, effective visualization of glottic structures, avoiding potential complications linked to traditional intubation. Significant Findings: • Technique Adaptation: The use of video laryngoscopy, especially in an awake state and lateral positioning, demonstrated an innovative airway management approach for difficult airways due to thyroid enlargement. • Enhanced Visualization: The video laryngoscope provided clearer glottic visualization, ensuring precise and timely intubation, which is critical in cases of acute respiratory distress. • Impact: This case underscores the value of adaptive strategies in emergency airway management, particularly for patients with complex anatomical challenges. The successful outcome emphasizes that, in settings with limited alternatives, awake video laryngoscopy in lateral decubitus is an effective technique to enhance patient safety. • Lesson Learned: In managing emergency airways complicated by anatomical abnormalities, particularly in resource-constrained environments, the combination of awake video laryngoscopy and lateral positioning can offer a safer, more controlled approach. This technique may serve as a reliable alternative in situations where standard approaches may fail or carry higher risks.