Laryngeal mass induced severe ventilatory impairment during induction of anesthesia

A 77-year-old man with laryngeal cancer was scheduled for total laryngectomy and lymph node dissection surgery under general anesthesia. The patient did not present with airway obstruction signs, including dyspnea or wheezing sounds during spontaneous respiration, and the laryngeal opening could be easily identified on the fiberoptic bronchoscope examination preoperatively. Due to his poor cognition and cooperation, we decided not to try awake fiberoptic intubation. During the induction of general anesthesia, total airway obstruction occurred a few minutes after muscle relaxation. The patient could not be ventilated by mask ventilation; nevertheless, tracheal intubation using a conventional laryngoscope was performed without difficulty. It turned out that even a laryngeal mass that does not cause obstructive symptoms, not large in size or totally blocking the airway, can cause difficulty in mask ventilation.