Awake Tracheal Intubation Using the ProVu™ Video Stylet in a Patient With Difficult Airway Due to Acromegaly

Acromegaly is characterized by progressive craniofacial and soft-tissue changes that can complicate airway management. Awake tracheal intubation (ATI) is recommended when a difficult airway (DA) is anticipated, particularly when the loss of spontaneous ventilation poses substantial risk. We report the case of a patient with acromegaly secondary to a pituitary macroadenoma who underwent transsphenoidal surgery. Preoperative awake airway assessment revealed severe upper airway narrowing, reduced nasal patency, and glottic restriction, which warranted the use of awake tracheal intubation. The airway was successfully secured using the ProVu™ Video Stylet (Flexicare Medical Ltd., Mountain Ash, United Kingdom) after topical anesthesia and light conscious sedation. The device facilitated the controlled advancement of the endotracheal tube under continuous visualization despite marked anatomic distortion. This case highlights the potential role of a steerable video stylet as an alternative to flexible bronchoscopy for patients with difficult airway anatomy.