Oral Fiberoptic Intubation Over a Retrograde Guidewire

Difficult airway in a child with spinal muscular atrophy type I

“…Retrograde intubation is one of the standard techniques for the management of a difficult airway. In most cases, a guide wire was inserted through the cricothyroid membrane and a fibreoptic scope used for minimal invasion and accuracy (5–7). However, in the presence of a tracheostomy and an appropriate tracheal tube introducer, retrograde intubation through the tracheostome can be useful (5).…”

Fluoroscopy assisted tracheal intubation in a case of anticipated difficult airway: Fail safe devices can also fail

“…Guiding the scope over or parallel to a retrograde guide wire is widely quoted in literature in difficult fiberoptic assisted intubations. [ 2 ] In our case, we could not use this technique as we were not prepared for retrograde intubation and without the light source and visual guidance passing the FOB over the guide wire might lead to airway trauma. As the fluoroscopy machine was in functional mode, and the attending anesthesiologists and radiologist were wearing radiation protective shield we considered fluoroscopy guided intubation.…”

Retrograde tracheal intubation

“…The use of the suction channel of the fibreoptic endoscope to guide it over a retrograde guide is dependent on a dry field for vision or operator skill with a fibreoptic scope. The retrograde guide is removed under vision and tracheal intubation is achieved by railroading the tube over the fibrescope [13,15,25,[79][80][81].…”

“…To bypass existing tracheostomy for better surgical exposure [4,[21][22][23][24] Trismus [1,5,25] Small mouth with protruding upper teeth [81] Congenital anomalies -resulting in micrognathia, short neck, large tongue, limited neck movement and mouth opening and cervical spine abnormalities [13,23,[26][27][28] Trauma -maxillofacial, cervical spine [10,11,16,29] Tumour -tongue, mandible, floor of the mouth, pharynx and larynx [6,9,12,15,81] Infection -retropharyngeal abscess [30], acute epiglottitis [31] Bone and joint disorders -rheumatoid arthritis, ankylosing spondylitis, unstable cervical spine [16,32,33] Obstructive Sleep Apnoea [12] Microstomia [12] Burns [34] Failed intubation With blind nasal, direct laryngoscopic or fiberoptic scope guided technique [5,8,11,18,19,24,28,[35][36][79][80][81] stiffer and more visible than 14-16G epidural catheters. Guide wires also stand prouder from the pharyngeal wall making retrieval easier and provide stronger support for guiding a tracheal...…”

“…The tip of the tube is harnessed either by retrograde guide stitched to it (4) or by a loop of retrograde guide tightened around it (5) and is then pulled down from the pharynx into the larynx. Suction catheters (cooled for added firmness) [66,67] Eschmann TM guide modified by severing the end [72] Guide wire sheath [3] Multi-lumen catheter [14] Airway exchange catheter [73] Custom made guide made by Cook (Cook Critical care, Bloomington, IN, USA) Flexible fibreoptic endoscope [13,25,[79][80][81] Anchor AG + RG Figure 4 In addition to an anterograde guide (AG) over retrograde guide (RG) an anchoring introducer is passed through the tracheal tube into the trachea. retrograde guide is released.…”