Purpose: We report two cases of difficult intubation where a laryngeal
mask airway (LMA) was used and changed to a conventional endotracheal
tube using a retrograde intubation set. Clinical findings: In two pat
ients, following induction of anaesthesia, the trachea could not be in
tubated in the conventional fashion with a blade. In both patients an
LMA was inserted to achieve an airway. In both patients intubation wit
h a conventional endotracheal tube was required. A Cook Retrograde Int
ubation Kit and fibreoptic bronchoscope were used to change the LMA to
conventional endotracheal tube without problems, Conclusion: The Cook
retrograde intubation allows an LMA to be replaced with an endotrache
al tube with an ID greater than 6 mm with a #3 or 7 mm with a #5 LMA.
This technique places an exchange stylet into the airway which is supe
rior to a conventional guidewire. This method allows the airway to be
maintained until the LMA is exchanged with an endotracheal tube. Anaes
thesia may be maintained and the airway instrumented without difficult
y using this technique.