Abstract
A 38-year-old male patient diagnosed with tongue cancer was scheduled to undergo tracheostomy to maintain the airway prior to chemotherapy. Salivary gland computed tomography showed a 4.0×4.6×5.3 cm mass on the right side of the base of the tongue. To prevent oxygen desaturation, preoxygenation was initiated with fraction of inspired oxygen 1.0 at a flow rate of 6 mL/min for. After preoxygenation, lidocaine was sprayed and infusion of remifentanil at 0.15 mcg/kg/min was initiated to reduce the irritation. When cricothyroidotomy is performed on awake patients, the risk of complications may increase because of pain, therefore, the otolaryngologist advised sedation since the patient was showing agitation. Cricothyroidotomy was performed by the otolaryngologist under a light sedation using 1.5 volume percent (vol. %) of sevoflurane, and a reinforced endotracheal tube (6.0) was inserted at the cricothyroidotomy site.
In order to minimize the occurrence of failure to deal with difficult airways, anesthesiologists should secure the patient’s airway according with difficult airway algorithms, and need to be prepared and trained to perform an invasive approach for difficult airway management in advance.

Key words: Airway management, cricothyroidotomy, difficult intubation, surgical airway, tongue cancer.