Case report:

“Patient scheduled for bilateral ureteric stent secondary to bilateral stones causing bilateral hydronephrosis, acute renal failure with anuria. On induction of anaesthesia unanticipated difficult airway and cannot intubate cannot ventilate scenario with front of neck access to secure his airway.”

Commentary:

This event is useful as an example of DAS Plan D in action [1].  It would be very helpful and hopefully reassuring for anaesthetists reading this vignette to know the outcome.  Whilst a difficult airway was not anticipated prior to induction, in retrospect there will be factors that would have led to difficulty in intubation – perhaps airway oedema in association with acute renal failure.

Reference:

[1] DAS Guidelines for Management of Unanticipated Difficult Intubation in Adults, 2015. Difficult Airway Society (DAS)