Introduction:

Difficult airway management is an important cause of morbidity and mortality, and the implementation of new techniques and devices has contributed to the reduction of complication rates.

Case presentation:

A 62-year-old woman with a large neck mass scheduled for palliative percutaneous tracheostomy in which awake intubation with videolaryngoscopy was performed successfully in the first attempt; additionally, it was necessary to perform percutaneous tracheostomy under ultrasound guidance because of the significant degree of anatomical distortion of her neck.

Conclusion:

There is little evidence about awake intubation with videolaryngoscope in patients with neck masses, which makes our case interesting. Ultrasonography should be immediately available in difficult airway cases, because it facilitates the identification of structures and helps guide percutaneous access in real time.

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