Cannot intubate cannot ventilate—focus on the 'ventilate'

In this issue, Tachibana and colleagues [1] have reported much dreaded ‘‘cannot intubate, cannot ventilate’’ during anesthesia. Their results suggest that this is uncommon (1 in 32,000 cases), but with potentially catastrophic outcomes. In the 1990s [2], the incidence of death or permanent brain damage associated with airway management during general anesthesia was found to be much higher than the incidence associated with cardiovascular management, and since then several major efforts have been made to reduce the serious adverse outcomes associated with airway management. These include guidelines for difficult airway management formulated by major anesthesiology organizations [3–5], development and use of new and reliable airway devices, and widespread monitoring with oximetry and capnography [6]. Nevertheless, a recent nationwide prospective survey (the 4th National Audit Project, NAP4) has shown that serious airway complications still occur for a small number of patients, with an estimated incidence of 1 per 5,000–22,000 patients in the UK [7]. The report of Tachibana and colleagues [1] indicates that Japan and, very likely, other nations face similar challenges. So what is new about the report of Tachibana and colleagues [1]? All the hospitals in Tachibana’s report were equipped with a videolaryngoscope (Pentax Airway Scope), which has advantages over conventional laryngoscopes. Tachibana’s report [1] indicates that the availability of videolaryngoscopes did not seem to reduce the incidence of ‘‘cannot intubate, cannot ventilate’’ situations if several attempts at tracheal intubation had been made with a conventional laryngoscope.