Anaesthetic Management of Pyelolithotomy Patient with Restricted Mouth Opening due to Previous Mandibular Surgery- A Case Report

Anaesthetic management of a patient with compromised kidney function, who had restricted mouth opening due to previous surgery for mandibular fracture requiring general anaesthesia, is a challenge for anaesthesiologists. This is a case report of a 45-year-old male patient with renal calculus who underwent left pyelolithotomy surgery under general anaesthesia at our institution. He was admitted with left loin pain of two weeks' duration. Airway control was difficult due to limited mouth opening resulting from mandibular fracture four months prior, for which he underwent open reduction and internal fixation at a different hospital. We anticipated difficulty in securing the airway due to mandibular plate fixation. The airway was secured with orotracheal intubation using a levitan optical stylet under airway block. This case report highlights the importance of optical stylet in the plan B of managing a difficult airway, when a fiberoptic bronchoscope is not available in a critical situation.