Awake nasal fibreoptic intubation in a 25‑year‑old patient with cervical trauma in a neurosurgical context

Airway management in patients with cervical spine injury is high risk in anesthesia because of potential neurological worsening with cervical spine movement. Contemporary recommendations emphasize maximal reduction of cervical movement, multidisciplinary planning, and use of a technique mastered by the operator. Awake fibreoptic tracheal intubation (AFOI) retains an important role in this context because it allows airway securement while preserving spontaneous ventilation and minimizing cervical motion. We report the case of a 25‑year‑old male road‑traffic accident victim with an unstable C5–C6 fracture‑dislocation and incomplete neurological deficit, scheduled for urgent decompression and fusion. Awake nasal fibreoptic intubation was chosen. Preparation included gargling with 2% viscous lidocaine 5 mL (100 mg), bilateral superior laryngeal nerve blocks with 1% lidocaine 2 mL per side (40 mg), and 2% lidocaine gel applied to the endotracheal tube and in the selected nostril (2 mL, 40 mg). The total lidocaine dose was therefore 180 mg, well below the recommended ceiling of 9 mg/kg lean body weight. The procedure allowed atraumatic intubation without desaturation, without significant hemodynamic instability, and without immediate neurological deterioration. This observation highlights the value of meticulous topical anesthesia and awake fibreoptic intubation in anesthetic management of cervical spine trauma in neurosurgery.