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(ie, the laryngopharynx and nasal cavities) for the presence of stenosis. Additionally, it is important to note the possibility for emergent reintubation when extubating a patient with JHF. In the present case, in addition to difficulties with intubation, the potential for emergent reintubation due to hemorrhage after gingivectomy could not be ruled out, so a tube exchanger was utilized. This research was originally published in the Journal of the Japanese Dental Society of Anesthesiology . 2020;48:7–9. REFERENCES 1

SARS-CoV-2 is 2 to 3 times more contagious than influenza and may aerosolize and remain longer than influenza virus. 2 , 3 Krause M, McWilliams S, Bullard K, et al. Neostigmine versus sugammadex for reversal of neuromuscular blockade and effects on reintubation for respiratory failure or newly initiated noninvasive ventilation: an interrupted time series design. Anesth Analg . 2020;131:141–151. Pulmonary complications related to residual neuromuscular blockade are associated with postoperative morbidity and mortality. Using an interrupted

first biopsy surgery, we were able to overcome the difficult nasotracheal intubation by guiding the nasotracheal tube via a gastric tube. We pulled out the tip of the gastric tube by a Magill forceps and advanced the tracheal tube from the nasal cavity to the pharynx without bleeding or damage to the nasopharynx. 8 In the second surgery, in which we were also concerned with postoperative airway edema, we used the AEC to allow rapid reintubation should compromised upper airway patency due to postoperative edema around the epiglottis be encountered, as has been

delicate nasal mucosa lining the septum. Nasal bleeding may even have originated elsewhere, such as within the oral cavity or at the actual surgical sites; regardless, the source must be identified so that hemostasis can be achieved. Second, any attempt at direct laryngoscopy, for visual inspection or for reintubation, or insertion of a supraglottic device is often quite difficult or impossible, as patients are typically conscious following extubation. Third, depending on the surgical procedure performed, which might include orthognathic surgery with maxillomandibular

facilitated nasotracheal intubation, while the oral bougie served as a standby for immediate reintubation by oral route in case the nasal tube could not be safely secured. This technique could also be useful for a trauma patient who initially is intubated orally for life-saving surgery and who then later comes to the operating room for facial fracture surgery requiring nasal intubation. In summary, conventional direct laryngoscopic examination and orotracheal intubation prior to attempting nasotracheal intubation and use of the two bougie technique enhances the safety