An anterior cervical and mediastinal mass causes “cannot intubate and cannot ventilate” after induction

Abstract

The perioperative management of a patient with a large anterior mediastinal mass is one of the major challenges for anesthesia care providers. If there is significant tracheal compression or the patient presents with difficult breathing, particularly in supine position, awake fiberscope intubation is usually indicated in order to avoid complete tracheal obstruction after induction. Here, we report a patient with a large anterior cervical and mediastinal mass, along with tracheal compression but no difficult breathing, even in the supine position. After intubation, nearly “cannot intubate and cannot ventilate” was encountered. This case demonstrates that absence of difficult breathing awake in the supine position in a patient with a large anterior mediastinal massdoes not rule out “cannot intubate and cannot ventilate” after induction. Very high inspiratory pressure during mask ventilation is needed to achieve effective mask ventilation.