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A persistent ‘can’t intubate, can’t oxygenate’ crisis despite rocuronium reversal with sugammadex

Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia


A ‘can’t intubate, can’t oxygenate’ airway crisis is a rare event which most anaesthetists will never experience during their career1,2. This report highlights the outcome of time-critical decisions in a potential airway catastrophe. Rocuronium was used as an alternative muscle relaxant for rapid sequence induction. The use of sugammadex in ‘can’t intubate, can’t oxygenate’ crises is discussed and highlights how, despite adequate reversal of neuromuscular blockade, the ‘can’t intubate, can’t oxygenate’ situation failed to resolve. An asymptomatic vallecular cyst was the causal factor in this scenario. Anaesthetic issues surrounding this pathology are discussed.

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