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Excerpt
We read with interest the article by Bissinger et al. [1]. However, we found that when a fiberoptic bronchoscope (FBS) mounted over retrogradely introduced guide wire reaches the guide wire's entry site, the anatomical landmarks frequently disappear as the FBS leans against the wall. One may thus feel insecure about withdrawing the guide wire, as the distance between the entry port (usually, the cricothyroid membrane) and vocal cords is very short and there is the chance of the FBS remaining proximal to the vocal cords. We have therefore developed an alternative approach.
A rigid plastic guide is slipped over the wire inserted retrogradely as has been recommended, then the endotracheal tube (ETT) (minimal internal diameter = 7.5 mm) is mounted over the guide with the pediatric FBS within it next to the guide. Afterward, the ETT is advanced to the guide wire's entry port. At this point, the FBS is advanced into the trachea, the guide and the guide wire are withdrawn, and the ETT is moved forward over the FBS. A rigid plastic guide is required, since a guide wire alone does not provide adequate support for advancement of the ETT.
We have found this technique to be uncomplicated and extremely reliable, as it allows the free use of the FBS within the ETT.
Leonid A.
