Fluoroscope-aided retrograde placement of guide wire for tracheal intubation in patients with limited mouth opening.
Passing a retrograde catheter/wire into the pharynx through a cricothyroid puncture can facilitate tracheal intubation in difficult situations where either a flexible fibre-optic bronchoscope or an expert user of such a device is not available. Some mouth opening is essential for the oral and/or nasal retrieval of the catheter/wire from the pharynx. Two patients with temporo-mandibular joint (TMJ) ankylosis and extremely limited mouth opening required gap arthroplasty of the TMJ under general anaesthesia. Because we did not have a flexible fibre-optic bronchoscope, we performed fluoroscopy-assisted nasal retrieval of the guide wire passed up through a cricothyroid puncture and subsequently accomplished wire-guided naso-tracheal intubation. In the absence of a flexible fibre-optic bronchoscope, this technique is a very useful aid to intubation in patients with limited mouth opening.
Department of Anaesthesia and Critical Care, B.P.Koirala Institute of Health Sciences, Dharan-18, Nepal. binsaiims@sify.com
B K
BK
Biswas
P
P
Bhattacharyya
S
S
Joshi
U R
UR
Tuladhar
S
S
Baniwal
D000328:Adult; D000844:Ankylosis / Q000150:complications* / Q000601:surgery; D002648:Child; D003413:Cricoid Cartilage / Q000601:surgery; D005471:Fluoroscopy; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D013705:Temporomandibular Joint Disorders / Q000150:complications* / Q000601:surgery; D013957:Thyroid Cartilage / Q000601:surgery