The retrograde tracheal intubation technique for difficult airway management: old but still working

Abstract

Tracheal intubation performed with direct laryngoscopy remains a preferred choice for securing the airway. In maxillofacial surgery patients, difficult airway may require using alternative techniques. Retrograde tracheal intubation (RTI) technique is an effective and safe option for some of these cases. We report our experience with a modified RTI technique in a 72-year-old man (body mass index, 20.3) affected by a pleomorphic adenoma of the lower jaw extending to the oropharynx and rhinopharynx. Our RTI technique included a 17-G Fantoni modified tracheal needle, a 150 cm long Teflon guide wire (SG), and an 83 cm long Cook airway exchange catheter. Preserving spontaneous breathing with a combination of propofol and remifentanil infusion, we performed RTI using a 17-G Fantoni cricothyrotomy needle inserted between first and second tracheal ring. The patient remained breathing spontaneously for the duration of the procedure, and his vital signs were maintained within normal limits. This case report offers an opportunity to discuss our experience and use of retrograde tracheal intubation. The RTI can be an alternative to awake intubation, and maintaining proficiency and training is necessary to guarantee favorable outcomes.