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scheduled surgery, a chest computed tomography (CT) scan was obtained, which showed extensive pneumomediastinum and subcutaneous emphysema ( Figure 1 ), resulting in postponement of the scheduled operations. The size of the pneumomediastinum had clearly decreased 1 week later ( Figure 2 ). The planned operations proceeded and were completed without incident. To prevent tension pneumomediastinum, the internal airway pressure was kept low, a sufficiently deep level of anesthesia was maintained, analgesia was well controlled, and muscle relaxants were continuously

stenosis or obstruction; however, subcutaneous emphysema and pneumomediastinum were evident. The cardiologists suspected that the ECG changes had been caused by pneumomediastinum as a complication of the tracheostomy. He presumed that the patient's heart had been compressed by air in the mediastinum. Cefazolin was intravenously administered to prevent infection associated with the subcutaneous emphysema and pneumomediastinum in the general hospital. The subcutaneous emphysema and pneumomediastinum resolved, and the patient returned to our hospital 4 days after her

blind retrograde fashion poses its own constraints. The guide wire can coil or break, damage airway structures, and, in rare cases, cause pneumomediastinum. 9 Passage of an FFB in lieu of a guide wire can help to mitigate many of the complications associated with the traditional guide-wire method. However, some possible limitations of this technique are that it requires availability of fiber-optic equipment and a skilled operator who can successfully navigate the airway anatomy in a potentially unfamiliar way. The FFB must also be long enough to transverse the