An anterior cervical and mediastinal mass causes “cannot intubate and cannot ventilate” after induction

We report a case of a 37-year-old woman with a large anterior cervical and mediastinal mass causing significant tracheal compression but no preoperative breathing difficulties, even in the supine position. After induction of general anesthesia, she experienced a “cannot intubate and cannot ventilate” scenario. Effective mask ventilation was achieved only with very high inspiratory pressures (up to 65 cmH2O) and prolonged inspiratory times. This case highlights that the absence of difficult breathing in the supine position does not preclude airway obstruction after induction, emphasizing the need for careful preoperative planning and readiness for emergent airway interventions.