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

ABSTRACT

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.