A Case of Successful Use of C-MAC® Video Laryngoscope in 'Cannot Ventilate' Situation Due to Unexpected Severe Narrowing of Laryngeal Inlet

예기치 못한 후두 입구 협착으로 인한 환기 부전 상황에서의 비디오 후두경의 유용성 1예

  • Moon, Jeong Hwan (Department of Otorhinolaryngology-Head & Neck Surgery, Dankook University College of Medicine) ;
  • Lee, Sun Hong (Department of Anesthesiology, Dankook University College of Medicine) ;
  • Kang, Bong Jin (Department of Anesthesiology, Dankook University College of Medicine)
  • 문정환 (단국대학교 의과대학 이비인후-두경부외과학교실) ;
  • 이선홍 (단국대학교 의과대학 마취통증의학교실) ;
  • 강봉진 (단국대학교 의과대학 마취통증의학교실)
  • Received : 2016.07.20
  • Accepted : 2016.09.04
  • Published : 2016.12.30


Although many factors associated with difficult intubation have been known, predictors of difficult mask ventilation are not well known. We experienced a case of nearly complete airway obstruction following usual anesthetic induction which needed various emergency treatments. The patient had a preoperative diagnosis of contact granuloma of right posterior vocal cord and bilateral vocal cord palsy but later was found out as invasive laryngeal cancer. Upon the surgical field of view, both vocal cords were showing significantly thickened and fixated appearance and was considered as in the critical narrowing state with the potential of complete obstruction. Using $C-MAC^{(R)}$ video laryngoscope we were able to see the narrowed vocal cord and choose proper size of endo-tracheal tube. Consequently, intubation was successfully done and operation was conducted. From this case, we have lessons that physicians should examine the patient's airway more carefully in case of laryngeal mass and prepare emergency measures.


Supported by : 단국대학병원


  1. Nishant A, Jamil A, Gideon B, Alistair B, Emma B, Shreerang A Bhide, et al. Anesthesia for Head and Neck Cancer. In: Montgomery PQ, Peter H RE, Patrik JG, editors. Principles and Practice of Head and Neck Surgery and Oncology. 2nd ed. London: Informa Healthcare;2009. p.104-16.
  2. Kheterpal S, Han R, Tremper KK, Shanks A, Tait AR, O'Reilly M, et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology 2006;105(5):885-91. https://doi.org/10.1097/00000542-200611000-00007
  3. Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015;1:1-22.
  4. Xiao HU, Shen X. Airway loss during inhalation induction of anesthesia with sevoflurane in a pediatric patient with laryngeal papillomatosis: A case report. Experimental and Therapeutic Medicine 2015;10(6):2429-31. https://doi.org/10.3892/etm.2015.2805
  5. Ho AM, Chung DC, To EW, Karmakar MK. Total airway obstruction during local anesthesia in a non-sedated patient with a compromised airway. Can J Anaesth 2004;51(8):838-41. https://doi.org/10.1007/BF03018461
  6. Bo L, Wang B, Shu SY. Anesthesia management in pediatric patients with laryngeal papillomatosis undergoing suspension laryngoscopic surgery and a review of the literature. Int J Pediatr Otorhinolaryngol 2011;75:1442-5. https://doi.org/10.1016/j.ijporl.2011.08.012
  7. Mahmoud M, Gunter J, Donnelly LF, Wang Y, Nick TG, Sadhasivam S. A comparison of dexmedetomidine with propofol for magnetic resonance imaging sleep studies in children. Anesth Analg 2009;109:745-53. https://doi.org/10.1213/ane.0b013e3181adc506
  8. Drummond GB. Comparison of sedation with midazolam and ketamine: Effects on airway muscle activity. Br J Anesthe 1996;76:663-7. https://doi.org/10.1093/bja/76.5.663
  9. Paton L, Gupta S, Blacoe D. Successful use of sugammadex in a 'can't ventilate' scenario. Anaesthesia 2013;68:861-4. https://doi.org/10.1111/anae.12338
  10. Ibinson JW, Ezaru CS, Cormican DS, Mangione MP. Glidescope use improves intubation success rates: an observational study using propensity score matching. BMC Anesthesiol 2014;101(14):1471-8.
  11. Aziz MF, Dillman D, Brambrink AM. Comparative effectiveness of the C-MAC videolaryngoscope versus diret larygoscopy in setting of the predicted difficult airway. Ansthesiology 2012;116:515-7. https://doi.org/10.1097/ALN.0b013e318246e866
  12. Moorthy SS, Gupta S, Laurent B, Weisberger EC. Management of airway in patients with laryngeal tumors. J Clin Anesth 2005;17:604-9. https://doi.org/10.1016/j.jclinane.2004.12.019