[Case of unexpected epiglottic cyst found during endotracheal intubation by an emergency medical technician trainee]

A 66-year-old man was scheduled for endoscopic right uretherectomy under general anesthesia. On the pre-anesthesia examination, the patient had no respiratory symptoms. An informed consent for endotracheal intubation by a trainee for emergency medical technician was obtained on the examination. General anesthesia was induced with propofol, ketamine, and fentanyl. The trainee ventilated the patient easily with facemask and succinylcholine was administered. On the attempt of endotracheal intubation by the trainee with video-laryngoscope (X-LITE VIDE), a huge epiglottic cyst was observed. Tracheal intubation was done safely by the responsible anesthesiologist. Laryngofiberscopic finding showed no respiratory sequlae such as bleeding from the cyst. Although the patient had been informed about the cyst before the surgery, he did not disclose it as he did not have any symptom from the cyst. This case suggest that unpredictable airway problem could occur in any anesthetic practice. The video-laryngoscope was useful in such a case to prevent fatal complication developing on endotracheal intubation by a trainee, and also it is a good tool to show the trainee how severe the cyst related-airway trouble would be.