Ventilation through placing the endotracheal tube passed down beyond the obstruction during general anesthesia in patient with mediastinal mass

Most common and featured complication in anesthetized patient with mediastinal mass is tracheobronchial compression distal to endotracheal tube. Because of reduced lung volume, relaxation of bronchial smooth muscle and eliminated diaphragm movement, general anesthesia exacerbate extrinsic intrathoracic airway compression. Once trachea or bronchus is collapsed, it is usually known to impossible to pass an endotracheal tube through compressed airway forcibly. However, if ventilation proves difficult, an attempt should be made to pass the endotracheal tube down the least obstructed portion and some cases reporting successful ventilation through placing endotracheal tube passed further down beyond the obstruction even after neuromuscular blockade. We describe the anesthesia experience that placing the endotracheal tube passed beyond the obstruction using fiberoptic bronchoscope in child with total tracheal obstruction after induction of general anesthesia.