Abstract
This case report describes the airway course of a 52-year-old male who required emergent exploratory laparotomy for suspected gastrointestinal perforation. The patient had underlying subglottic stenosis and unilateral vocal cord paralysis, as well as a history of significant cardiopulmonary disease. Attempts at intubation using standard tube sizes were unsuccessful. A 6.0 endotracheal tube was eventually passed beyond a point of resistance, allowing the operation to proceed. He remained intubated after surgery and was successfully extubated several days later. The report emphasizes the need for adaptable airway plans and highlights the constraints that may arise during urgent operative care.