Successful use of sugammadex in a 'can't ventilate' scenario

A 53-year-old man with hypopharyngeal stenosis following curative chemoradiotherapy for a tongue base tumour presented three years later for an attempt at pharyngeal dilatation. The first attempt 6 months previously was abandoned when awake fibreoptic intubation failed due to partial airway obstruction and desaturation when the fibrescope was advanced. As mask ventilation was anticipated to be possible, a further attempt at intubation after induction of anaesthesia was judged appropriate. The backup plan was jet ventilation via a cricothyroid cannula sited pre-induction. However, neither mask nor jet ventilation proved possible after the induction of anaesthesia and neuromuscular blockade with rocuronium. Swift administration of sugammadex on a background of thorough pre-oxygenation allowed return of spontaneous breathing before the development of hypoxia and so avoided the need for surgical airway rescue. This case demonstrates the utility of sugammadex in restoring spontaneous respiration in a 'can't ventilate' scenario, provided that the airway has not been traumatised by instrumentation.