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BJA Advance Access originally published online on October 14, 2004
British Journal of Anaesthesia 2005 94(1):128-131; doi:10.1093/bja/aeh297
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004

CASE REPORT

Fluoroscope-aided retrograde placement of guide wire for tracheal intubation in patients with limited mouth opening

B. K. Biswas1,*, P. Bhattacharyya1, S. Joshi1, U. R. Tuladhar1 and S. Baniwal2

1 Department of Anaesthesia and Critical Care and 2 Department of Oral and Maxillofacial Surgery, B.P.Koirala Institute of Health Sciences, Dharan-18, Nepal

* Corresponding author. E-mail: binsaiims{at}sify.com

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.


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