Retrograde intubation (RI) was discussed in Chapter 22. Although reported success rates are high, RI remains a “blind” procedure: the endotracheal tube (ETT) is advanced with wire guidance, and there is no visualization of the glottis as the tube is moved forward. The ETT may move out of the larynx, into the esophagus, or kink, with failure to advance, after the wire and guide catheters are removed. To improve the success of RI, it can be combined with a fiberoptic bronchoscope (FOB) in order to obtain direct visualization of the airway as the tube is advanced and immediately confirm appropriate placement of the ETT.¹,² When the guidewire is retrieved from the mouth, it is fed through the working channel of the FOB from distal to proximal. The FOB is then fed over the wire to the glottis. After the wire is removed, the FOB acts as a visualizing guide catheter. This reduces the chance that the ETT will be dislodged from the trachea during the blind technique, as the glottis can be visualized throughout.

Case reports attest to the use of this combination of airway management techniques.¹,²,³