Retrograde Intubation Using the Subcricoid Region

Lleu, J.C.; Forrler, M.; Pottecher, T.; Otteni, J.C.

doi:10.1093/bja/69.5.542

Cited by 7 publications

(10 citation statements)

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“…[5] Also, over-sedation with the agent might lead to respiratory distress, and a ‘cannot intubate cannot ventilate’ situation might arise. Retrograde passage of an epidural catheter through the cricothyroid membrane and passage of a tracheal tube over the catheter from above,[8] or introduction of a trans-tracheal cannula was also an option[9] but was discarded due to large thyroid mass and indistinct anatomical landmarks. Due to the airway problems encountered with thyroid disease, thyroidectomy under local anesthesia was advocated by some anesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

Airway management of a difficult airway due to prolonged enlarged goiter using loco-sedative technique

Srivastava

Dhiraaj

2013

Saudi J Anaesth

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Appropriate airway management is an essential part of anesthesiologist's role. Huge goiters can lead to distorted airway and difficulty in endotracheal intubation. In this report, we present a case of a 67-year-old woman with a huge toxic multinodular thyroid swelling, gradually increasing in size for last 20 years, where trachea was successfully intubated. She had a history of deferred surgery in June 2007 due to inability to intubate, despite 5-6 attempts using different laryngoscopes, bougie, and stylet. Patient was re-admitted in December 2011 for the surgery and was successfully intubated this time with help of fiberoptic intubation using loco-sedative technique. Patient was electively kept intubated postoperatively in view of chances of tracheomalacia due to prolonged large goiter. She was extubated successfully on post-op day 2 after demonstration of leak around trachea following tracheal tube cuff deflation. The different techniques of managing the difficult airway in these patients are discussed.

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Section: Discussionmentioning

confidence: 99%

Airway management of a difficult airway due to prolonged enlarged goiter using loco-sedative technique

Srivastava

Dhiraaj

2013

Saudi J Anaesth

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“…It is devoid of blood vessels or nerves, and sits cephalad of the thyroid gland (which typically ascends to the second tracheal ring, although a pyramidal lobe may extend toward the hyoid bone [44]). The distance from the vocal cords (2.5 cm) is double the distance between the cords and the standard cricothyroid puncture site, thereby lessening the chance that bleeding or edema at the puncture site will result in hoarseness or subglottic edema [42], as well as reducing the chance of directly injuring the vocal cords when the needle is introduced [45]. Other authors have postulated that the cricotracheal membrane may be a more suitable site for RI [42, 45], but, to our knowledge, no published studies comparing the different techniques exist.…”

Section: Discussionmentioning

confidence: 99%

Does the Site of Anterior Tracheal Puncture Affect the Success Rate of Retrograde Intubation? A Prospective, Manikin-Based Study

Harris

Arheart

Fischler

2013

Anesthesiology Research and Practice

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Background. Retrograde intubation is useful for obtaining endotracheal access when direct laryngoscopy proves difficult. The technique is a practical option in the “cannot intubate / can ventilate” scenario. However, it is equally useful as an elective technique in awake patients with anticipated difficult airways. Many practitioners report difficulty successfully advancing the endotracheal tube due to anatomical obstructions and the acute angle of the anterograde guide. The purpose of this study was to test whether a more caudal tracheal puncture would increase the success rate. Methods. Twenty-four anesthesiology residents were randomly assigned to either a cricothyroid or a cricotracheal puncture group. Each was instructed how to perform the technique and then attempted it on a manikin at their assigned site. Data collection included whether the trachea was intubated, the number of attempts required, and the total time. Results. Both groups displayed a high degree of success. While the group assigned to the cricotracheal site required significantly more time to perform the procedure, they accomplished it in fewer attempts than the cricothyroid group. Conclusion. Retrograde intubation performed via a cricotracheal puncture site, while more time consuming, resulted in fewer attempts to advance the endotracheal tube and may reduce in vivo laryngeal trauma.

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“…Retrograde Intubation (RI) 30 RI technique is an accepted mode of establishing airway in difficult airway scenario.…”

Section: Retromolar Scope Guided Intubation (Bonfils)mentioning

confidence: 99%

Evolution of Airway Devices

Shelgaonkar¹,

Adate²,

Shinde³

et al. 2012

IJPUT

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Maintenance of patent airway is essential for adequate oxygenation and ventilation. Failure, even for a short period can be life-threatening. So expertise in airway management is essential in every medical speciality. Management of the airway has come a long way since the endotracheal intubation done by Macewan (1880) to present day use of modern and sophisticated devices. The wide variety of airway armamentarium is available today. Since, time available to secure airway is short one has to be optimally prepared with proper selection of equipment, technique and participation of personnel experienced in doing it. This is a brief review of evolution of airway devices.

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Retrograde Intubation Using the Subcricoid Region

Cited by 7 publications

References 0 publications

Airway management of a difficult airway due to prolonged enlarged goiter using loco-sedative technique

Airway management of a difficult airway due to prolonged enlarged goiter using loco-sedative technique

Does the Site of Anterior Tracheal Puncture Affect the Success Rate of Retrograde Intubation? A Prospective, Manikin-Based Study

Evolution of Airway Devices

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