Summary Both the American Society of Anesthesiologists and the Difficult Airway Society of the United Kingdom have published guidelines for the management of unanticipated difficult intubation. Both algorithms end with the ‘can't intubate, can't ventilate’ scenario. This eventuality is rare within elective anaesthetic practice with an estimated incidence of 0.01–2 in 10 000 cases, making the maintenance of skills and knowledge difficult. Over the last four years, the Department of Anaesthetics at the Royal Perth Hospital have developed a didactic airway training programme to ensure staff are appropriately trained to manage difficult and emergency airways. This article discusses our training programme, the evaluation of emergency airway techniques and subsequent development of a ‘can't intubate, can't ventilate’ algorithm.

Inadequate methadone is a risk factor for opioid withdrawal. A daily starting methadone dose equivalent to 2.5 times the daily fentanyl dose is effective in minimizing withdrawal symptoms.

The Bispectral Index correlates well with the Ramsay score in the normal sedated child. The Ramsay score and bedside nurse assessment are inadequate for monitoring the depth of sedation in paralyzed children. The Bispectral Index is a useful adjunct in assessing sedation in a paralyzed patient.

SciPhon is a software for the reduction of nuclear resonant inelastic X-ray scattering data. Tests and examples of applications to Fe, Kr, Sn, Eu and Dy data are presented.

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Cannula tracheotomy in a model comparable to the infant airway is difficult and not without complication. Cannulae of 14- and 18-gauge appear to offer similar performance. Successful aspiration is the key predictor of appropriate cannula placement. The Quicktrach Child was not used successfully in this model. Further work is required to compare possible management strategies for the CICO scenario.

If a 'can't intubate, can't oxygenate' scenario occurs in a patient with unidentifiable anterior neck airway anatomy in a location where an ultrasound machine is immediately available, we recommend that consideration is given to the use of ultrasound-guided cannula tracheotomy as the first-line rescue technique.

Assessed for eligibility (n=27) Excluded (n=7)  Not meeting inclusion criteria (n=2)  Declined to participate (n=4)  Other reasons (n=1) Analysed (n=10)  Excluded from analysis (give reasons) (n=0) Lost to follow-up (give reasons) (n=0) Discontinued intervention (give reasons) (n=0) Allocated to intervention (n=10)  Received allocated intervention (n=10)  Did not receive allocated intervention (give reasons) (n=0) Lost to follow-up (give reasons) (n=0) Discontinued intervention (give reasons) (n=0) Allocated to intervention (n=10)  Received allocated intervention (n=10)  Did not receive allocated intervention (give reasons) (n=0) Analysed (n=10)  Excluded from analysis (give reasons) (n=0) Allocation Analysis Follow-Up Randomized (n=20)