Retrograde intubation: An old new technique

Abstract

Introduction In the last decade, a new boom of scientific articles about retrograde intubation has been published. Case reports, applications, technique variations and comparison with other techniques reintroduce the scientific discussion of the technique, its indications, contraindications, complications and technical advances. Despite the complications and contraindications linked to retrograde intubation, its utility is incontestable in specific situations. Although the success rate of retrograde intubation is variable, some authors affirm that in the hands of those who use the technique frequently, retrograde intubation appears to have a high success rate. We believe that training in retrograde intubation would definitely be an advance that could increase the success rate of the technique as well as decrease the complications associated with it. Conclusion Recent developments are happening to enhance the retrograde intubation technique, such as the combination with laryngeal nerve block, fibre optic bronchoscopy and ultrasound guidance. During the booming phase of advances in airway management technologies, anaesthesiologists should sometimes return to the basics and learn and practice simple techniques like retrograde intubation that can save patient lives.

Wire guided fibreoptic retrograde intubation in a case of glottic mass

“…Retrograde intubation, a technique developed in the 1960s by Butler and Cirillo, had been frequently used for difficult intubation prior to the advent of flexible fibreoptic bronchoscopy. [ 1 2 3 ] In patients, where a patent airway is not visible, passing fibreoptic bronchoscope blindly can lead to undue complications such as trauma, laryngospasm, bleeding and further worsening of an already compromised airway. Hence, by combining both techniques, the advantages afforded by both can be superimposed to our benefit.…”

Retrograde nasal intubation using nasogastric tube saves the day

“…While it may never have the popularity of other airway management techniques, it is an useful alternative in some difficult intubation situations where ventilation is secured, such as trauma, upper airway masses, bleeding, secretions or anatomical anomalies. [ 2 ] Recent advances including the combination of retrograde intubation and fiber optic bronchoscopy,[ 3 ] using ultrasound guidance,[ 4 ] and Cook ® Retrograde Intubation Sets have renewed interest in this old technique.…”