© Acta Anæsthesiologica Belgica, 2015, 66, n° 3 Abstract : Introduction : Expertise in airway manage- ment is a fundamental aspect of anesthesia practice. Fortunately ‘can’t intubate, can’t ventilate’ scenarios are extremely rare. In particular, patients with tumors on the right side of the oropharynx and larynx can be very problematic to intubate. Methods : We present an alternative intubation techni- que, whereby a C-MAC D-blade videolaryngoscope is loaded with a Frova catheter in the narrow, curving chan- nel within the blade’s infero-posterior aspect on the left side of the blade. This technique can be a successful alternative in patients with diffcult airways. Results : The proposed technique was successfully demonstrated in a case whereby a 47-year old male with premetrics of a diffcult airway, presented with a large mass in the right supraglottis and hypopharynx with through-and-through thyroid cartilage infltration, obstructing completely the view of the glottis with direct laryngoscopy. The referral hospital considered the pa- tient unintubatable and sent the patient to our academic center for treatment. Endotracheal intubation with the new technique was successful at the frst attempt. Conclusions : The C-MAC D-Blade videolaryngoscope- bougie technique provides an alternative method to intu- bate patients with diffcult airways, even in exceptional situations such as in patients with a large right-sided oropharynx-larynx tumor. Key words : Larynx tumor ; failed intubation ; CICO ; videolaryngoscopy ; frova catheter. IntroductIon Endotracheal intubation can be challenging in patients with diffcult airways. According to the NAP4-study, a ‘can’t intubate, can’t ventilate’ sce- nario occurs in fewer than 1 in 5,000 routine general anesthesia procedures, but accounts for up to 25% of all anesthesia-related deaths (1-4). Videolaryngoscopy offers advantages over classic laryngoscopy, especially in patients with dif- fcult airways (5-7). We suggest an alternative intu- bation method to those currently available by utilis- ing the C-MAC ® -D-blade (8) videolaryngoscope (Karl Storz, Tuttlingen, Germany) and a bougie/ introducer with a ‘railroad’ technique. case report A 47-yr-old indigenous male (height : 160 cm ; weight : 54 kg ; BMI : 21 kg/m 2 ; ASA 4, Mallam- pati grade IV, mouth opening 2 cm, thyromental distance 5.2 cm) presented with a 2 week history of dysphagia and hemoptysis. He was a long-term chronic alcohol abuser and smoker, and reported re- cent 5-10 kg of weight loss and hypertension. Chest X-ray showed the appearance of a right-sided laryn- geal tumor with an abnormal lymph node, deemed likely to be malignant. CT scan confrmed a laryn- geal primary tumor eroding into the thyroid carti- lage staged at T4aN2M0, obliterating completely the right side of the glottis entrance. PET scan dem- onstrated a mass in the right supraglottis and hypo- pharynx with through-and-through thyroid cartilage infltration and bilateral nodal metastases. Inciden- tally, the right palate also appeared ‘hot’ on PET scan. Flexible nasal endoscopy showed a large supraglottic lesion on the right false cord extending (Acta Anaesth. Belg., 2015, 66, 87-90) André A. J. Van Zundert, Professor of Anaesthesiology, M.D., Ph.D., F.R.C.A., E.D.R.A., F.A.N.Z.C.A ; Stephen P. Gatt, Associate Professor of Anaesthesiology, M.D., F.A.N.Z.C.A., F.R.C.A., F.C.I.C.M. (*) Department of Anaesthesiology and Perioperative Medi- cine, The University of Queensland School of Medicine & Royal Brisbane & Women’s Hospital, Brisbane, Qld, Australia. (**) Department of Anaesthesia, Wales Anaesthesia, Prince of Wales Hospital and the University of New South Wales, Randwick, NSW, Australia. Corresponding address : Prof. André Van Zundert, Professor & Chair Discipline of Anesthesiology, The University of Queensland, Faculty of Medicine & Biomedical Sciences, Royal Brisbane & Women’s Hospital, Ned Hanlon Building – level 4, Department of Anaesthesia & Perioperative Medi- cine, Butterfeld St, Herston-Brisbane, Queensland 4029, Australia. Tel. : +61 7 3646 5673. Fax : + 61 7 3646 1308. E-mail : vanzundertandre@gmail.com and gattsp@gmail.com A novel method of intubation and orogastric tube insertion using a C-MAC-D-blade videolaryngoscope-bougie technique a. a. J. Van Zundert (*) and s. p. Gatt (**)