Difficult airway is defined as situation that face mask ventilation, laryngoscopy, or intubation cannot be done by clinician as easy as he expects where it. Difficulties in children airway management do not occur frequently and aggressive airway management in children is not required often.We present a case of "cannot ventilate, cannot intubate" scenario in a five years old girl with a supraglottic cyst in operating room. We started to sedate the patient with ketamine for awake intubation but the cyst obstructed the airway and we couldn’t ventilate her with mask. Two try of intubation with tube and bougie were failed and rigid bronchoscope could maintain the airway finally.

The present study reports a 42 years old male patient with modular thyroid cancer. The patient became candidate for direct laryngoscopy (DL) in order to observe the condition of the lesion in the trachea and probable biopsy, and subsequent surgery. After a few moments, it was observed that the patient cannot be ventilated. Immediately, the patient was tried to be intubated but was not successful and thus, quick track was put for the patient rapidly and he was connected to the jet ventilation machine. But after a short time, suddenly the patient got bradycardia and respiratory interruption and drop in saturation that the patient underwent CPR operation which continued for 30 seconds which resulted finally in the patient’s heart rate reaching 100 and spontaneous breathing began. After auscultation of lungs, bilateral pneumothorax was diagnosed that according to previous studies, is probably a complication resulting from trans tracheal jet ventilation (TTJV). This complication was resolved through needle aspiration. After 4 hours, the surgery was over and the patient, with stable vital signs and spontaneous breathing, was sent to the intensive care unit.In some previous studies, the researchers have suggested using open surgical technique in order to reduce the complications resulting from cannot intubate, cannot ventilate (CICV), and the present study also supports this suggestion and recommends it to other anesthesiologists when facing CICV situation, in order to reduce the complications resulting from jet ventilation and its subsequent damages.

Aspiration under general anaesthesia is a dreaded complication which can significantly affects the morbidity and mortility in the postoperative period. Factors such as delayed gastric emptying seen in obesity, pregnancy, paralytic ileus, altered consciousness as under general anaesthesia, head injury can predispose the patient to pulmonary aspiration. The two entities aspiration pneumonia and aspiration pneumonitis although difficult to differentiate in the early course of event but it is of crucial importance to know the pulmonary pathology for effective management of the patient. A morbidly obese patient was posted for fracture humerus surgery under GA who landed in cannot ventilate situation, had pulmonary aspiration which was managed efficiently in ICU.

Background: Cytoglobin (Cygb) is a relatively newly identified globin protein that acts as an oxygen transporter in tissues like hemoglobin (Hb) in erythrocytes and myoglobin (Mb) in muscles. The natural oxidation of the Fe2+ ion in its heme group into metglobin (globin-Fe3+) made the loses of oxygen binding functions. It is known metHb and metMb can be reduced enzymatically using diaphorase or cyb5r3. However, metCygb reductase had not been previously identified. This study aims to analyze the reducing activity of bovine diaphorase on metCygb. Methods: Diaphorase was isolated from bovine erythrocyte and purified using gel filtration and cationicexchanger chromatography. Its purity was verified by SDS-PAGE and western blot (WB). The metCygb was obtained from Cygb oxidation with potassium ferrocyanide and its reducing activity was determined by spectroscopy. Results: The diaphorase (MW=30. 09 kDa) was purified 10. 77-fold from crude enzyme with specific activity against metHb 8. 479 U/mg. The purity was confirmed by WB using primary antibody anti-cyb5r3. The purified enzyme reduced metCygb at 0. 785 μ, gmin-1, which was 13. 7 times less than the Vmax of metHb. Conclusions: In conclusion, the purified diaphorase from bovine erythrocytes did not significantly reduce metCygb rather than metHb, a natural substrate in cells.