Facilitating GlideScope intubation with the straight end of an endotracheal tube introducer.

or respiratory compromise. However, on sternotomy incision, the infant experienced sudden treatable ventricular fibrillation, likely a result of his tenuous cardiac status. Complete repair of the total anomalous pulmonary venous return occurred. He was extubated on postoperative day three, and subsequent chest films showed significantly improved tracheal alignment. Further delineation of other possible causes of tracheal deviation were not worked up due to the urgent need for surgery. Infants with cardiac defects also may have undiagnosed airway anomalies. These may be intrinsic anomalies such as tracheal stenosis or, as in our case, tracheal deviation secondary to massive cardiomegaly. When considering induction of anesthesia in a patient in whom tracheal compression and obstruction are possible, it is important to have all necessary equipment in the room (Laryngeal Mask Airway, rigid bronchoscope), and an ENT and cardiac surgeon available in case conversion to extracorporeal membrane oxygenation or cardiopulmonary bypass is necessary.