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GENERAL ARTICLES

Radiologic-Assisted Endotracheal Intubation

Charles E. Reier, MD^*, and Allan R. Reier, MD

*Department of Anesthesia, Jay County Hospital, St. Vincent Randolph Hospital, Winchester, Indiana; and Department of Interventional Radiology, Washington University Medical Center, St. Louis, Missouri

Address correspondence and reprint requests to Charles E. Reier, MD, 520 Wildrose Drive, Greenville, OH 45331. Address e-mail to rreier{at}hotmail.com

We accomplished endotracheal intubation by using fluoroscopic direction in a patient presenting a difficult airway both on the basis of a preanesthetic physical examination and on the basis of a potential for cervical cord injury associated with complicated laryngoscopy. Under topical anesthesia, a multipurpose angiographic (MPA) catheter over a Bentson wire was advanced into the trachea under intermittent C-arm fluoroscopic guidance while the occiput, cervical spine, and mandible remained in a neutral position. The endotracheal tube was then easily advanced over the MPA catheter into the trachea, where the location was documented by fluoroscopic view. Because of judicious use of topical anesthesia and the small diameter and flexibility of the MPA catheter, the unsedated patient remained comfortable throughout the procedure. The stored data were later transferred to a compact disk, and a copy was provided to the patient as an adjunct to Medic-Alert. Unlike fiberoscopy, with which the view can be totally obscured by secretions, blood, and abnormal anatomy, the direction and location of the MPA catheter within the airway were easily identifiable throughout the procedure. The small diameter of the MPA (1.5-mm outer diameter) should allow placement of endotracheal tubes as small as 3.0-mm inner diameter—an option not available even with pediatric instruments. Although time was not a consideration, the procedure was accomplished in <12 min with 22 s of fluoroscopy. We believe that with experience, atraumatic intubation of a difficult airway could be accomplished routinely in less than 2 min with radiological-assisted intubation.

IMPLICATIONS: Radiologic-assisted intubation facilitated endotracheal intubation without sedation, instrumentation, or significant movement of the occiput, cervical spine, or mandible. The procedure was accomplished in <12 min and with only 22 s of fluoroscopy. This approach provides the ultimate adjunct to the preoperative airway physical evaluation while providing for immediate (or delayed) atraumatic endotracheal intubation. The diagnostic information and procedure can be recorded on a compact disk.

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