[Problematic intubation in the patient with laryngeal-hypopharyngeal carcinoma. Retrograde controlled fiber...

Retrograde or fiberoptic intubation techniques are recommended for patients in whom intubation is difficult; however, each method has its own limitations. Good results have been reported with a combination of both techniques, i.e. retrograde passage of a guidewire through the cricothyroid membrane to guide a fiberoptic bronchoscope. The practicality, success and complication rates of our retrograde-guided fiberoptic bronchoscopic technique (RGFT) were studied prospectively in 93 patients with obstructing tumors scheduled for laryngectomy. The techniques showed itself to be successful, practical and safe, with negligible complications in 89/93 patients (96%). The ability to insert the bronchoscope by means of a guidewire and to direct the intubation procedure optically was found to be advantageous. Limitations with extreme obesity and in two other patients with advanced obstructive carcinomas of the larynx. Additionally, use of the tracheal puncture allows the RGFT to be integrated into clinical medical education as a preparatory exercise for emergency coniotomy.