Awake Fiberoptic Intubation for Cervical Lipoma Excision: A Case Report

Airway management in patients with cervical masses poses significant challenges, particularly in resource-limited settings where advanced equipment may be unavailable. This case report describes a 45-year-old female with a large cervical lipoma (8 cm) causing restricted neck extension, admitted for surgical excision under general anesthesia. Due to the mass’s size and location, standard dorsal positioning was unfeasible. The patient was positioned semi-upright using a customized foam cushion, and awake fiberoptic intubation was performed following bilateral occipital nerve and superficial cervical plexus blocks with 0.5% lidocaine. Minor bleeding occurred during ventilation but was managed with tranexamic acid and compression, avoiding hemorrhagic shock. The procedure was successful, with complete mass excision, and the patient was extubated within 90 minutes, showing no residual lesions on postoperative ultrasound. This case highlights the efficacy of awake fiberoptic intubation and adaptive positioning in managing complex airways in resource-constrained environments, emphasizing the need for standardized guidelines to address such scenarios.