Induction of anaesthesia in patient with cervical region mass can result in a ‘cannot intubate, cannot ventilate’ situation orcomplete loss of the airway. We present one year old baby with a massive swelling of the neck complaining of stridor and dysphagia posted for planned excision.CT scan showed 15× 15 cms mass infiltrating the tissue planes and pushing the trachea to the opposite side and ensheathing the major vessels. Neck X-ray showed deviated and compressed airway just below the vocal cords. Operation theatre was prepared for difficult airway management (equipment and expertise)

After non-sedative premedication and monitoring for ECG, Pulseoximetry, gas monitoring,inhalation induction wasdone withSevoflurane 0-8 % and intubation attemptedwithMcintosh no. 2 twice andwith no. 3 blade oncebut failed. Cormack Lehane view was grade IV. Ventilation was spontaneous and adequate. Fiber-optic Bronchoscopeassisted intubation tried but failed.Retrograde intubation was planned as a next measure.An 18 G intravenous canula was inserted throughcricothyroid membrane into the trachea. Through this canula,18 G epidural catheter was passed in retrograde manner and retrievedfrom the oral cavity. Over this catheter 3.5 No endotracheal tubewas threaded but it couldnot cross the cords.A smaller tube and rotation of the tube did not work. The patient was stable with spontaneous respiration and oxygen saturation.Optimistic intubation trial attempted using the epidural catheter as reference point for intubation .This time the tube could be successfully inserted beyond the vocal cords.Total time of induction tillsuccessful intubation was two hours.