Retrograde intubation with a Mini-Trach II kit

Retrograde intubation has been accepted internationally as a viable alternative for managing the difficult airway. Various techniques have been described to perform this procedure, however, difficulties have arisen on account of problems with suboptimal materials. We therefore describe a retrograde intubation technique using the knife and stiff plastic introducer from a Mini-Trach II set from Portex Ltd (Kent, UK).

The cricothyroid membrane was identified and using the knife from the mini-trach set, incised longitudinally. The plastic introducer was inserted through the incision and maneuvered out through the mouth providing a guide over which the endotracheal tube was threaded. The technique was evaluated on 20 cadavers and thereafter used in four patients.

Mean intubation time in the 20 cadavers was 6.7 s (range 3-10) from incision to removal of the guide. Also, the technique was used successfully in four patients in whom anterograde attempts failed. In one of these patients the retrograde intubation was life saving.

Retrograde intubation with a stiff curved plastic introducer was rapid and easy in cadavers and in four patients. In emergency situations where conventional intubation fails it may be life saving.