<![CDATA[Difficult intubation is a challenge for an Anesthesiologist. Expertise in effective airway management which includes initial assessment to follow-up care. In this article we reported a 58-year-old male with a history of tracheostomy, craniotomy, and Open Reduction and Internal Fixation (ORIF) placement on the maxilla dextra, who will undergo a cranioplasty procedure under general anaesthesia. On physical examination, a mallampati class IV assessment was obtained, the distance between incisors < 3 fingers. The pre-anesthesia assessment an American Society of Anesthesiologist (ASA) II with LEMON score of 4. The intraoperative process used intravenous induction with fentanyl 150 mg, midazolam 5 mg, Propofol 150 mg, and Rocuronium 50 mg. Two airway management scenarios in this patient failed, which were video-assisted laryngoscopy and fibre optic laryngoscopy, therefore a third scenario was performed using retrograde intubation technique. Retrograde intubation is an effective alternative in patients with intubation difficulties.]]>
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