"Cannot-ventilate" after anesthetic induction in a patient with rapidly increased laryngeal tumor

A 76-year-old male patient with laryngeal tumor was scheduled for elective laryngo-microsurgery. He had no dyspnea nor symptoms of obstructive lung disease detected by spirometry. Preoperative finding by laryngoscopy showed decreased movement of the left vocal cord. However, no significant narrowing was found in the glottis. Following anesthetic induction with fentanyl and thiamylal, the lungs could not be ventilated with anesthesia circuit even by use of oral airway device. After his resuming spontaneous breathing, assisted ventilation became possible. However, the lungs could not be ventilated again after vecuronium i.v. The vocal cords could not be visualized by direct laryngoscopy with a Macintosh blade. The trachea was intubated with a tracheal tube (I.D. 6.0 mm) by blind technique, and mechanical ventilation was established. The intraoperative laryngomicroscopy showed that the laryngeal tumor had grown rapidly occupying the glottis except posterior commissure. We should be careful of rapid preoperative growth of the laryngeal tumor.