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Fibreoptic aided retrograde intubation in an oral cancer patient.

Das S, Mandal MC, Gharami BB, Bose P - Indian J Anaesth (2011)

View Article: PubMed Central - PubMed

Affiliation: North Bengal Medical College, West Bengal, India.

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Recently we encountered such a patient and we combined both retrograde and fibreoptic (FOB) intubation in a difficult airway situation, compromised by a large oral cavity mass... We had three options: blind nasal, FOB and tracheostomy... Blind nasal is a simple technique, but success at first pass is less and there is more trauma and bleeding with more attempts... This may result in failure to visualise during subsequent FOB attempts... In retrograde intubation, the endotracheal tube may move out of the larynx into the oesophagus or kink with failure to advance after guide catheters are removed... Herein lies the importance of this modified technique that utilises a guidewire introduced with the retrograde approach which is subsequently used to guide the FOB for speedy advancement into the oropharynx occupied with tumour... We used a sterile Terumo guidewire intended primarily to cannulate the common bile duct... The tip of this guidewire is very soft and becomes slimy in the presence of water so that it finds its way even in a small opening... So, chance of retrieving the catheter from the mouth or nostril at first pass, in the presence of an airway tumour, is more... Though not impossible, tracheostomy under local anaesthesia is difficult in advanced oropharyngeal cancers causing anatomical distortion of the anterior neck... This combination technique may be helpful to secure the airway reliably, safely and quickly in oral cancer patients requiring awake tracheal intubation for anticipated difficult airway situations.

No MeSH data available.


FOB loaded with a tracheal tube showing both ends of the Terumo guide wire. (a) Distal end of the guidewire, (b) guidewire through the right nostril, (c) proximal end of the guidewire through the proximal end of the working channel of the FOB
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Figure 0002: FOB loaded with a tracheal tube showing both ends of the Terumo guide wire. (a) Distal end of the guidewire, (b) guidewire through the right nostril, (c) proximal end of the guidewire through the proximal end of the working channel of the FOB

Mentions: An awake, right nasotracheal intubation was planned. After preparation of the patient for an awake intubation, the cricothyroid membrane was punctured with a Tuohy needle through which a Terumo guide wire was fed in. A red rubber catheter was used to take the guide wire from the mouth through the right nostril. The flexible tip of the Terumo was fed through the distal end (2.8 mm) of the working channel of the FOB (OD 5.8 mm) to come out through the proximal end of the working channel. A fibrescope with a preloaded tracheal tube was rail-roaded through the right nostril through the trachea [Figure 2].


Fibreoptic aided retrograde intubation in an oral cancer patient.

Das S, Mandal MC, Gharami BB, Bose P - Indian J Anaesth (2011)

FOB loaded with a tracheal tube showing both ends of the Terumo guide wire. (a) Distal end of the guidewire, (b) guidewire through the right nostril, (c) proximal end of the guidewire through the proximal end of the working channel of the FOB
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3106402&req=5

Figure 0002: FOB loaded with a tracheal tube showing both ends of the Terumo guide wire. (a) Distal end of the guidewire, (b) guidewire through the right nostril, (c) proximal end of the guidewire through the proximal end of the working channel of the FOB
Mentions: An awake, right nasotracheal intubation was planned. After preparation of the patient for an awake intubation, the cricothyroid membrane was punctured with a Tuohy needle through which a Terumo guide wire was fed in. A red rubber catheter was used to take the guide wire from the mouth through the right nostril. The flexible tip of the Terumo was fed through the distal end (2.8 mm) of the working channel of the FOB (OD 5.8 mm) to come out through the proximal end of the working channel. A fibrescope with a preloaded tracheal tube was rail-roaded through the right nostril through the trachea [Figure 2].

View Article: PubMed Central - PubMed

Affiliation: North Bengal Medical College, West Bengal, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Recently we encountered such a patient and we combined both retrograde and fibreoptic (FOB) intubation in a difficult airway situation, compromised by a large oral cavity mass... We had three options: blind nasal, FOB and tracheostomy... Blind nasal is a simple technique, but success at first pass is less and there is more trauma and bleeding with more attempts... This may result in failure to visualise during subsequent FOB attempts... In retrograde intubation, the endotracheal tube may move out of the larynx into the oesophagus or kink with failure to advance after guide catheters are removed... Herein lies the importance of this modified technique that utilises a guidewire introduced with the retrograde approach which is subsequently used to guide the FOB for speedy advancement into the oropharynx occupied with tumour... We used a sterile Terumo guidewire intended primarily to cannulate the common bile duct... The tip of this guidewire is very soft and becomes slimy in the presence of water so that it finds its way even in a small opening... So, chance of retrieving the catheter from the mouth or nostril at first pass, in the presence of an airway tumour, is more... Though not impossible, tracheostomy under local anaesthesia is difficult in advanced oropharyngeal cancers causing anatomical distortion of the anterior neck... This combination technique may be helpful to secure the airway reliably, safely and quickly in oral cancer patients requiring awake tracheal intubation for anticipated difficult airway situations.

No MeSH data available.