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CRITICAL CARE AND TRAUMA

Emergent Retrograde Tracheal Intubation with a Gum-Elastic Bougie in a Trauma Patient

From the Department of Anesthesia, Metrohealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Address correspondence and reprint requests to Donn Marciniak, MD, Department of Anesthesia, 2500 Metrohealth Dr., Cleveland, OH 44109. Address e-mail to dmarciniak78{at}yahoo.com.

BACKGROUND: Patients with severe maxillofacial trauma pose a challenge when their airways must be secured. Often, emergent surgical airways are established when largyngoscopy or fiberoptic intubation are unsuccessful. When an airway cannot be surgically established, the anesthesiologist is forced to use novel approaches to airway management, but there are few descriptions of such techniques in the literature.

METHODS: After unsuccessful laryngoscopy and a failed cricothyroidotomy and tracheostomy in a patient with deforming maxillofacial trauma, a gum-elastic bougie was inserted retrograde through a tracheal defect in a cephalad manner and exited the patient's mouth.

RESULTS: The patient was successfully intubated using a modified retrograde technique through a tracheal defect with a gum-elastic bougie.

CONCLUSIONS: When an uncontrolled airway cannot be secured surgically and a tracheal defect is present, retrograde intubation with a gum-elastic bougie may be considered as an emergent management option.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999