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| LETTER TO EDITOR |
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| Year : 2011 | Volume
: 55
| Issue : 3 | Page : 321 |
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Is central-line guidewire sufficient for retrograde intubation?
Harihar V Hegde, P Raghavendra Rao, Shrirang V Torgal
Department of Anaesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| Date of Web Publication | 7-Jul-2011 |
Correspondence Address:
Harihar V Hegde
Department of Anaesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka - 580 009
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-5049.82671
How to cite this article:
Hegde HV, Rao P R, Torgal SV. Is central-line guidewire sufficient for retrograde intubation?. Indian J Anaesth 2011;55:321 |
Sir,
A recent article by Kishan Rao Bagam et al.[1] reported successful retrograde intubation as a rescue airway in an unanticipated difficult airway scenario. The authors have rightly highlighted the usefulness of this airway management technique in managing difficult airways if fibreoptic bronchoscope is not available. They had used a guidewire that is used for central venous cannulation during the procedure.
The length of the guidewire supplied with the commercially available central venous catheterisation sets is about 45 cm. During retrograde intubation, the guidewire needs to be firmly held at both the ends while railroading the endotracheal tube (ETT). An 8-mm internal diameter PVC ETT (with the connector) measures about 35 cm in length. Therefore, it is recommended that the length of the guidewire used should be slightly more than twice the length of the ETT. The commercially available Cook Retrograde Intubation Set contains a 110-cm long, 0.97-mm diameter guidewire. [2] Many anaesthesiologists use guidewires used in cardiac catheterisation or ureteric stent or sometimes, epidural catheters which are much longer than the CVC guidewires. After reading this case report, out of curiosity, we also measured the distance between the lips and the cricoid region during fibreoptic intubation in an average adult male which was about 18 cm. By these measurements, it is clear that the minimum length of the guidewire required is greater than 50 cm (even if the ETT connector is removed before railroading the ETT), unless the ETT itself is shortened by cutting. Therefore, we wonder how the authors could use the guidewire used for central venous cannulation. Our guess is that the authors have probably successfully railroaded the ETT without securing the proximal (oral) end of the guidewire which may not be a safe technique in all the patients. Unless the guidewire is held at both the ends, it may get kinked or lost during the procedure. Or else, the authors have tied something to the proximal end of the guidewire after retrieving it at the mouth.
The authors have also mentioned about the airway parameters like mouth opening, lip biting, temperomandibular joint subluxation and Mallampati grade being assessed in the same patient with a Glasgow Coma Scale (GCS) = 10. It is beyond our comprehension how these details of the airway could be obtained in a patient who had altered sensorium with a GCS of 10. Our sincere opinion is that these types of errors should be avoided in a peer-reviewed journal to maintain appropriate standards. We hope that our comments are taken in the right spirit for which they are meant to be.
 References | |  |
| 1. | Bagam KR, Murthy S, Vikramaditya C, Jagadeesh V. Retrograde intubation: An alternative in difficult airway management in the absence of a fiberoptic laryngoscope. Indian J Anaesth 2010;54:585. 
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| 2. | Arndt GA, Topp J, Hannah J, McDowell TS, Lesko A. Intubation via the LMA using a Cook retrograde intubation kit. Can J Anaesth 1998;45:257-60.
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