Alternatives to general anaesthesia for adult tracheostomy: a case report

Abstract

A 72-year-old male patient with a laryngeal mass under evaluation is presented. The mass significantly reduces the airway lumen and prevents conventional endotracheal intubation. Progressive worsening of dyspnea and laryngeal stridor over 4 weeks led to his admission to the emergency department. An awake tracheostomy was performed under conscious intravenous sedation, bilateral superficial cervical plexus block, and humidified high-flow oxygen therapy. The procedure was carried out with the patient in a semi-seated supine position, maintaining oxygen saturation (SpO₂) between 99% and 100% throughout. This innovative approach represents a safe and effective strategy for managing an anticipated difficult airway, supported by current evidence.