A modification in the tube guide to facilitate retrograde intubation: A prospective, randomised trial

Abstract

Background:The technique of anterograde over a retrograde guide is considered to be more reliable and preferable in comparison to only retrograde one, for improving the success rate of retrograde intubation. As the prior technique requires a lengthy guidewire to negotiate the whole channel of a tube guide, we designed a side eye at one end of tube guide, which obviated the above requirement while maintaining the integrity of the whole channel assembly. The efficacy of this modified technique was compared with the conventional one for retrograde intubation procedure.Methods:In a prospective, randomised fashion, 98 cases posted for surgery of carcinoma buccal mucosa were included in this trial. These cases were randomised to the conventional (Group I) or the modified technique (Group II) for retrograde intubation. Intubation time (first attempt), total number of successful intubations, cause of failures and any associated side effects were recorded and compared between the groups.Results:The total number of successful intubations were significantly higher in group II (95.83%, 46/48 cases) as compared to group I (66.66%, 31/48 cases) (P<0.001). Mean intubation time was 118±22 second in group I versus 124±26 second in group II (P=0.39). The side effects did not differ significantly between the groups.Conclusions:Improvising the tube guide resulted in a significant rise in the number of successful intubations through a modified retrograde intubation technique, with no side effects. This should encourage the use of retrograde intubation technique as a first option for difficult airway management.

Retrograde intubation in a dog with severe temporomandibular joint ankylosis: case report

“…In humans, the insertion of a catheter into the trachea before the removal of the guide wire may help to cope with this problem [ 20 ]. Anterograde over a retrograde guide may improve the efficacy of RI and is considered to be a more reliable and preferable technique for improving the success rate [ 33 ] without prolonging its duration [ 20 ].…”

“…In human medicine complications of RI are few; the most common is a sore throat, affecting 60% of the patients [ 45 ]. More severe complications are rare and the most common include hypoxemia, cough, laryngospasm/bronchospasm [ 46 ], development of hematoma, incorrect site of tube placement, procedure time greater than or equal to 3 min, unsuccessful tube placement, laryngeal fracture with permanent dystonia [ 33 ], pneumomediastinum [ 20 ], subcutaneous emphysema [ 47 ], infection, and bleeding [ 48 ].…”

Fracture of the insertion cannula during retrograde intubation: a rare complication

“…Retrograde intubation is an option in cases of difficult airway access, especially in developing countries where a flexible fiberoptic bronchoscope is not available because of cost/expertise issues. The success of retrograde intubation depends on personal expertise and technical skill [ 1 ]. Here, we report a case of a unique complication encountered during this procedure.…”