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BJA Advance Access published online on October 14, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh297
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted August 19, 2004

Case Report

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

B. K. Biswas 1*, P. Bhattacharyya 1, S. Joshi 1, U. R. Tuladhar 1, and S. Baniwal 2

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

* To whom correspondence should be addressed. E-mail: binsaiims{at}sify.com.


  Abstract

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.

Keywords: equipment, fluoroscope; equipment, guide wire; intubation, retrograde; surgery, cricothyrotomy.
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