A Review of Intubation Techniques in Anaesthetic Management of Temporomandibular Joint Ankylosis

Intubation of a patient with temporomandibular joint ankylosis is a challenge for every anaesthesiologist. Dependable anaesthetic technique is most desired by all anaesthesiologists. The purpose of the present article is to have a brief overview of temporomandibular joint ankylosis, its clinical features, management and to review literature demonstrating various intubation techniques available to an anaesthesiologist while managing patients with temporomandibular joint ankylosis.

Retrograde Intubation An Alternative Way For Endotracheal Intubation Using Epidural Catheter As A Guide – A Case Report

Patients having restricted mouth opening and limited movement of tempro-mandibular joint present as difficult airway scenario. Fibre-optic assistance is a gold standard technique for anticipated difficult intubation, but it’s availability and expertise still is a challenge at most of places worldwide especially in developing countries.The retrograde intubation technique can be an alternative and less invasive than other emergency surgical airway options for such cases. We present a case of difficult intubation, successfully managed with the help of retrograde intubation.

Retrograde and Antegrade Intubation: Improvisation of Conventional Technique of Retrograde Intubation in Indian Scenario

To have a definite airway is must in case of intraoral bleeds or long surgeries. Highest challenge of difficultintubation is when mouth opening is nil or it is impossible to relax the jaw even after administration of musclerelaxants. In this study conventional retrograde intubation technique was compared and evaluated with improvisedretrograde and antegrade intubation for securing airway in difficult intubation cases on the basis of efficacyand complication rate. Patients were randomized into two groups of 10 each. They were prepared for awakenasal intubation and were kept NPO overnight with the procedure explained beforehand. Premedication donewith injection glycopyrrolate 0.04 mg/kg IV and injection midazolam 0.03 mg/kg IV. In operation theatrestandard monitoring was done. Induction and maintenance of anaesthesia was done as per routine protocol.Independent observer recorded the time required for securing the ETT from cricothyroid puncture to theconfirmation of tube placement, number of attempts required, any desaturation during the procedure andhaemodynamic changes. Postoperatively assessment was done two hours later for hoarseness of voice, painin throat, coughing, subcutaneous emphysema, assessment for any cartilage injury and/ or local haematomaby an ENT surgeon. During the study, it has been seen that the retrograde and antegrade intubations might bemore efficacious with lower complication rates. Hence this modified technique with improvisation ofconventional technique can be recommended for regular use in Indian scenario.

Comparison of effect of lacrimal ducts retrograde intubation and dacryocystorhinostomy in treating chronic dacryocystitis / 中国基层医药

Objective To compare the effect of lacrimal ducts retrograde intubation and dacryocystorhinosto-my in treating chronic dacryocystitis.Methods 104 patients with chronic dacryocystitis were selected and divided into observation group and control group by lottery.There were 64 cases in observation group and 40 cases in control group.Lacrimal ducts retrograde intubation was given in observation group,while dacryocystorhinostomy was given in control group.Same postoperative care was given in both two groups.The surgery related conditions and effect of treat-ment were compared.Results There were 63 effective cases in the observation group in 3 months after operation,the effective rate was 98.44%,40 effective cases in the control group,the effective rate was 100.00%,and there was no significant difference between the two groups (χ2 =0.185,P >0.05).There were 62 effective cases in the observation group in 6 months after operation,the effective rate was 96.88%,40 effective cases in the control group,the effective rate was 100.00%,and there was no significant difference between the two groups (χ2 =0.306,P >0.05).There were 59 effective cases in the observation group in 12 months after operation,the effective rate was 92.19%,38 effective cases in the control group,the effective rate 95.00%,and there was no significant difference between the two groups (χ2 =0.227,P >0.05).The mean operation time in the observation group was (10.8 ±2.7)min,while (0.1 ± 9.6)min in the control group,the mean operation time in the observation group was shorter than that in the control group(t =18.074,P <0.05).The mean hospitalization in the observation group was (2.5 ±0.3)days,while (6.3 ± 1.4)days in the control group,the mean hospitalization in the observation group was shorter than that in the control group(t =3.171,P <0.05).The mean hospital expenses in the observation group was (1467.1 ±26.7)yuan,while (1971.6 ±59.1)yuan in the control group,the mean hospital expenses in the observation group was less than that in the control group(t =39.482,P <0.05).Conclusion The recent therapeutic effects of lacrimal ducts retrograde intubation and dacryocystorhinostomy in treating chronic dacryocystitis were same,and it was safer,lower operative difficult,less treatment expenses to applying lacrimal ducts retrograde intubation.It was worthy of clinical application.

Kinked J-tip guidewire within the tracheal lumen during retrograde intubation: A case report

Retrograde intubation is an alternative option for gaining airway access for patients with a difficult airway.We report a successful management of a kinked J-tip guidewire within a tracheal lumen with flexible fiberoptic laryngoscope in a patient with type II odontoid fracture.It is helpful to adjusting the depth of angiocatheter and handling of J-tip guidewire if J-tip guidewire does not come out into the oral cavity at the expected length during retrograde intubation.

Retrograde Tracheal Intubation through Cricothyroid Membrane and Cricotracheal Ligament / 대한마취과학회지

Numerous devices and techniques have been devised to facillitate the difficult endotracheal intubation. Percutaneous retrograde intubation was first described by Waters, who used a Tuohy needle to puncture the cricothyroid membrane and an epidural catheter as a guideline in 1963 and many variations on the technique have been described. Failure to intubate 2 male adult patients were planned retrograde tracheal intubation using the cricothyroid membrane. While the patients were awake, and after adequate local anesthesia was obtained, a 16G Medicut was punctured through cricothyroid membrane. After confirmation of the intratracheal position by aspiration of air into syringe, the opening of the Medicut was directed upward foward the larynx and the epidural catheter was inserted through it and advanced retrograde between the vocal cords and into mouth. The epidural catheter tip was passed through the Murphy's eye from outside to inside and out of the tracheal tube. By keeping the catheter taut and coincidently pulling back, the tube was advanced into trachea. Correct positioning of the tracheal tube inside the trachea was confirmed by end-tidal carbon dioxide monitoring and auscultation. Another 2 male adult patients were intubated by using cricotracheal retrograde approach method. We experienced successful retrograde tracheal intubation without significant complications using an epidural catheter through cricothyroid membrane and cricotracheal ligament in 4 male adult patients who were predicted impossibility of simple orotracheal intubation. (Korean J Anesthesiol 1995; 29: 304~309)

Retrograde Nasogracheal Intubation with Laryngeal Mask Airway / 대한마취과학회지

Retrograde intubation has been often used in the patient who reveal difficulty intubation. But, it is time consuming procedure and the patient may be fall into hypoxemia. We have experienced a successful retrograde nasotracheal intubation without hypoxemia by using the Laryngeal Mask Airway. After induction of inhalation anesthesia, ordinary endotracheal intubation was failed in this 45-year-old male patient who was planned to clip the cerebral aneurysm, because the epiglottis could not be seen under direct laryngoscopy. We decided to perform retrograde nasotracheal intubation. Face mask was replaced with Laryngeal Mask Airway and ventilation was continued during procedure. A 18-gauge Tuohy needle was introduced through the cricothyroid membrane and then the epidural catheter was passed cephalad to larynx, distal hole of Laryngeal Mask Airway, and the end of Laryngeal Mask Airway. A 16-F Levin tube was introduced through right nasal cavity and Laryngeal Mask Airway was removed, the Levin tube was tied with epidural catheter in the oral cavity. The epidural catheter was placed from cricothyroid membrane to right nares. The endotracheal intubation was performed successfully by sliding over the catheter. In the postoperative evaluation, significant complications were not detected. The procedure was performed in about 2 minutes and the apneic time was less than 30 seconds. We believe that this procedure may be useful in the patients who may suffer from hypoxemia.

Retrograde Intubation Technique Used Epidural Catheter; 3 Cases / 대한마취과학회지

Sometimes, anesthesiologist may have get a chance as if he can not intubate with ordinary direct laryngoscopy. At that time he must decided that intubation technique will try to again or not. If we have a decision as we will try to continue for intubation and we can not use any other intubation technique, we can have a decision to use retrograde intubation technique so as to intubate in trachea instead of direct laryngoscopy. If patient have much secretion, blood clot and laryngeal edema after had many times of direct laryngoscopy, fiberoptic bronchoscopy will be impossible. Since Buttler and Cirillo on 1960, retrograde intubation technique was improved markedly. Especially, most important improved point about this technique is that what things are used for guide wire. Recently, most of authors have been used for guide wire as CVP catheter, Swan-Ganz introducer wire or epidural catheter. But I used to epidural catheter for guide wire and patients have not any complication with this retrograde intubation technique. Finally, we concluded that retrograde intubation technique is one of good intubation technique and can do without any complicaions.

Retrograde Endotracheal Intubation Using a Guide Wire in a Pediatric Patient / 대한마취과학회지

An 8-year-old male with ankylosis of both temporomandibular joints was scheduled for an elective condylectomy. Physical examination revealed a relatively healthy appearing child, weighing 25 kg, with 5-7mm of maximal oral opening. The EKG, chest x-ray and laboratory data were within normal limits. An attempt at local infiltration after injection of droperidol 2.5 mg for retrograde technique was unsuccessful. Subsequently, anesthesia was induced with thiopental, halothane, nitrous oxide and oxygen via a mask. The cricothyroid membrane was punctured with an 18 gauge Touhy needle. After confirmation of the intratracheal position by aspiration of air into a fluid filled syringe, a flexible guide wire tip of CVP catheter (VYGON) was threaded via this needle superiorly into the posterior pharynx through the larynx. After introduction of the guide wire into right naris, the nasotracheal tube was threaded over the wire, and the tip of the tube in the trachea at the site of the cricothyroid membrane puncture was confirmed by palpation and visual inspection. The nasotracheal tube was advaned further into the trachea after removal of the guide wire. Auscultation confirmed appropriate intratracheal placement.