Management of Anticipated Difficult Airway in a Case of Neurofibromatosis during the COVID-19 Pandemic

Neurofibromata with a potential to affect the airway occur mostly in the head, neck, face and larynx, posing a risk to the airway and making intubation difficult. Management of an anticipated difficult airway needs special precautions and airway protection strategies during the COVID-19 pandemic. A 50-year-old woman was scheduled for excision of cervical neurofibroma measuring 6.6 cm × 7.2 cm on the right side of nape of neck, resulting in limited neck extension. We decided to intubate this patient under anaesthesia as against an awake fibreoptic intubation for three reasons. Our patient was not willing for awake intubation, we wanted to prevent aerosolisation during intubation and computerised tomography of the chest showed signs of postinfective sequelae probably suggestive of a lower respiratory tract infection. All precautions to protect the airway operator from aerosol exposure were followed such as using an aerosol box and a videolaryngoscope. Our case highlights the importance of collaborative decision-making, careful preparation and thorough management of anticipated difficult airway in neurosurgery patients during the COVID pandemic.