title: A modification in the tube guide to facilitate retrograde intubation: A prospective, randomised trial.
abstract: BACKGROUND
  The technique of anterograde over a retrograde guide is considered to be more reliable and preferable in comparison to only retrograde one, for improving the success rate of retrograde intubation. As the prior technique requires a lengthy guidewire to negotiate the whole channel of a tube guide, we designed a side eye at one end of tube guide, which obviated the above requirement while maintaining the integrity of the whole channel assembly. The efficacy of this modified technique was compared with the conventional one for retrograde intubation procedure.
  
  
  METHODS
  In a prospective, randomised fashion, 98 cases posted for surgery of carcinoma buccal mucosa were included in this trial. These cases were randomised to the conventional (Group I) or the modified technique (Group II) for retrograde intubation. Intubation time (first attempt), total number of successful intubations, cause of failures and any associated side effects were recorded and compared between the groups.
  
  
  RESULTS
  The total number of successful intubations were significantly higher in group II (95.83%, 46/48 cases) as compared to group I (66.66%, 31/48 cases) (P<0.001). Mean intubation time was 118±22 second in group I versus 124±26 second in group II (P=0.39). The side effects did not differ significantly between the groups.
  
  
  CONCLUSIONS
  Improvising the tube guide resulted in a significant rise in the number of successful intubations through a modified retrograde intubation technique, with no side effects. This should encourage the use of retrograde intubation technique as a first option for difficult airway management.
authors.affiliation: Department of Anaesthesia, Teerthankar Mahaveer Medical College, Moradabad, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Jain
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Singh
authors.forename: Ghanshyam
authors.initials: G
authors.lastname: Yadav
authors.forename: Surender K
authors.initials: SK
authors.lastname: Gupta
authors.forename: Santosh
authors.initials: S
authors.lastname: Tharwani