A Modification of Retrograde Wire-Guided, Fiberoptic-Assisted Endotracheal Intubation in a Patient with Ankylosing Spondylitis

Abstract

The use of a retrograde guidewire technique to assist in the management of the difficult airway was first reported in 1981 (1). Since then, modifications of this technique have included the use of the fiberoptic bronchoscope (FOB) to permit tracheal intubation under direct visual control (2-6). One disadvantage with retrograde technique is that, with removal of the retrograde guidewire, the FOB and endotracheal tube (ETT) may inadvertently slip into the esophagus as their advancement is attempted. A modification of retrograde wire-guided fiberoptic-assisted endotracheal intubation was described in 1983 (7) in which the FOB is passed next to, not over, the guidewire to eliminate this disadvantage. We illustrate here the usefulness of this method in the management of the difficult airway.