• Kohji Uzawa, Joho Tokumine, Alan Kawarai Lefor, Toshiyuki Takagi, Kunitaro Watanabe, and Tomoko Yorozu.
• From the Department of Anesthesiology (KU, JT, KW, TY), Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo; Department of Surgery (AKL), Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi-ken; and Department of Anesthesia (TT), Higashiyamato Hospital, Nangai, Higashiyamato, Tokyo, Japan.
• Medicine (Baltimore). 2016 Apr 1; 95 (15): e3383.

AbstractThe "cannot ventilate, cannot intubate" scenario during anesthesia induction can be lethal. We present a patient with an undiagnosed subglottic tumor who developed the "cannot ventilate, cannot intubate" situation after induction of general anesthesia, due to the presence of an undiagnosed subglottic tumor. A 93-year-old woman was brought to the operating room for repair of a femoral neck fracture. Both ventilation and intubation could not be accomplished, and the patient was awakened without complications after trials of maintaining the airway. In order to reverse muscle relaxation, sugammadex was useful to allow resumption of spontaneous breathing. A difficult airway can be caused by an undiagnosed subglottic tumor. Subglottic tumors can be misdiagnosed as asthma, because the clinical presentation can be very similar. If cricothyrotomy had been performed based on airway management algorithms, the airway may not have been controlled with a possibly fatal outcome. Ultrasound examination of the trachea may be useful to diagnose obstructive lesions in the airway.

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