Elective tracheostomy in a covid patient with carcinoma palate in covid intensive care unit – clinical dilemma of a surgeon

Difficult airway is an unfortunate and a possibly fatal condition that could be encountered in an emergency situation. Basic airway knowledge and timely action need to be taken to secure an airway in such patients. Patients with difficult airway may present with a myriad of signs and symptoms including respiratory distress and stridor. Multiple methods of securing an airway are available such as endotracheal intubation (both oropharyngeal and naso-pharyngeal), supraglottic airway devices, fibre-optic intubation, cricothyrotomy and tracheostomy. The clinical dilemma surrounds the time and kind of method to me used in such a situation. We share our experience from a covid intensive care unit wherein a patient diagnosed with locally advanced carcinoma of palate of right side extending upto the midline leading to restricted mouth opening. Patient was symptomatic with breathlessness requiring non invasive ventilation. Our approach to this situation and the decision making has been explained in this article.