Traditional retrograde intubation consists of tracheal intubation performed over a guide wire inserted into the trachea inferior to the vocal cords and then passed transorally or transnasally. This intubation technique is reserved for patients with a difficult airway when other methods such as blind nasal intubation or video laryngoscopy fail. A guide wire passed blindly in a retrograde fashion, however, is not without its own constraints. This case report presents the anesthetic management of a 23-year-old Duchenne muscular dystrophy patient with substantial scarring from a previous tracheostomy stoma and limited mouth opening. The patient underwent a retrograde fiber-optic transnasal intubation without the use of a guide wire for a tracheostomy revision procedure, followed by a second tracheostomy revision and retrograde fiber-optic transoral intubation 7.5 months later. This report demonstrates a novel technique for intubating patients with difficult airways. The use of a flexible fiber-optic bronchoscope for a retrograde intubation mitigates complications that can arise using traditional retrograde intubation over a guide wire and increases the likelihood of successful intubation.
Retrograde Intubation Over a Flexible Fiber-Optic Bronchoscope
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Ramanjot S. Kang, Robert Hutnik, Ishu Kant, Aaron Zlatopolsky, Chamandeep Brar, Slawomir P. Oleszak; Retrograde Intubation Over a Flexible Fiber-Optic Bronchoscope. Anesth Prog 1 April 2022; 69 (1): 42–45. doi: https://doi.org/10.2344/anpr-68-04-01
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