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the machine that shares the same Galvanic cell oxygen analyser between the common gas outlet and the patient breathing system. This case reinforces several important points for anaesthetists. Depending on its design, leaks identified on the breathing system may be located within the anaesthetic machine and will be inaccessible to clinicians. Such a leak would be particularly alarming if it happens during surgery as it makes identification and correction of the leak difficult.Alternative methods of ventilation and provision of anaesthesia should always be available. Anaesthetists also need to understand the design of their anaesthetic machine in order to anticipate these problems and to correctly locate the source of a leak. It is a fallacy to assume that the universal leak test would exclude all leaks within the anaesthetic machine.

A 94-year-old female presented to the emergency department with acute expiratory stridor. In the absence of an otorhinolaryngologist, an urgent laryngoscopy was performed using a flexible bronchoscope by an anaesthesiologist in the emergency department leading to a change in management. Subsequent radiographs confirmed severe tracheal compression from megaoesophagus secondary to achalasia as the cause of acute airway obstruction. Use of flexible bronchoscope as a diagnostic tool by an anaesthesiologist to evaluate a patient presenting with signs of acute airway obstruction may lead to a safer and more careful airway management planning. Suggestions are also made regarding establishment of emergency surgical airways when conventional approaches fail.