Retrograde Nasogracheal Intubation with Laryngeal Mask Airway

Kim, Young Ki; Kang, Soon Ho; Kim, Young Dae; Kim, Pil Gon

Abstract

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.