When the view into the upper airway is obscured by tumor, blood, or other visual obstructions of the upper airway, it can be helpful to introduce a guide from below the glottis directed cephalad to the mouth or nose, and use this to direct an endotracheal tube (ETT) into the trachea. Although the ETT is passed through the glottis in an antegrade direction, this technique is referred to as retrograde intubation. Retrograde intubation of the trachea was first described in 1960 by Butler and Cirillo . The technique involves introduction of a wire through the cricothyroid membrane or the membranous space between the cricoid cartilage and the first tracheal ring into the airway. The wire is then directed cephalad and is used to help guide an ETT into the trachea. Although infrequently used, retrograde intubation can be an extremely useful tool in the anesthesiologist’s armamentarium for managing difficult airways, and it has been used successfully in many clinical situations. Common indications for the procedure include failure of other airway techniques, anatomical abnormalities, and the presence of blood or secretions in the proximal airway that obscure the glottic structures. Specialized kits are available that include all the necessary equipment for retrograde intubations (e.g., the Cook Retrograde Intubation Set, Cook Incorporated, Bloomington, IN), but the necessary supplies—consisting of a long guide wire approximately 0.38′′ caliber, a needle or large-bore intravenous catheter able to accommodate the guide wire, a hemostat, and a tube exchange catheter—are usually available without one of these kits.
Guide Wire Difficult Airway Constrictive Pericarditis Cricoid Cartilage Tracheal Ring
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Parmet JL, Metz S. Retrograde endotracheal intubation: an underutilized tool for management of the difficult airway. Contemp Surg. 1996;49:300–6.Google Scholar
Bissinger U, Guggenberger H, Lenz G. Retrograde-guided fiberoptic intubation in patients with laryngeal carcinoma. Anesth Analg. 1995;81:408–10.PubMedGoogle Scholar
Practice guidelines for management of the difficult airway; an updated report by the ASA task force on management of the difficult airway. Anesthesiology.2003; 98:1269–77.Google Scholar
Wong DT, Lai K, Chung FF, Ho RY. Cannot intubate-cannot ventilate and difficult intubation strategies: results of a Canadian national survey. Anesth Analg. 2005;100:1439–46.PubMedCrossRefGoogle Scholar
Lechman MJ, Donahoo JS, Macvaugh H. Endotracheal intubation using percutaneous retrograde guidewire insertion followed by antegrade fiberoptic bronchoscopy. Crit Care Med. 1986;14:589–90.PubMedCrossRefGoogle Scholar
Bhardwaj N, Yaddanapudi S, Makkar S. Retrograde tracheal intubation in a patient with a halo traction device; Letter to editor. Anesth Analg. 2006;103:1628–9.PubMedCrossRefGoogle Scholar
Marciniak D, Smith CE. Emergent retrograde tracheal intubation with a gum-elastic bougie in a trauma patient. Anesth Analg. 2007;105:1720–1.PubMedCrossRefGoogle Scholar
Lenfant F, Benkhadra M, Trouilloud P, Freysz M. Comparison of two techniques for retrograde tracheal intubation in human fresh cadavers. Anesthesiology. 2006;104(1):48–51.PubMedCrossRefGoogle Scholar
Hatton KW, Price S, Craig L, Grider JS. Educating anesthesiology residents to perform percutaneous cricothyroidotomy, retrograde intubation, and fiberoptic bronchoscopy using preserved cadavers. Anesth Analg. 2006;103:1205–8.PubMedCrossRefGoogle Scholar
Salah N, Mhuircheartaigh RN, Hayes N, McCaul C. A comparison of four techniques of emergency transcricoid oxygenation in a manikin. Anesth Analg. 2010;110(4):1083–5.PubMedGoogle Scholar