BACKGROUND:Retrograde intubation has been accepted internationally as a viable alternative for managing the difficult airway. Various techniques have been described to perform this procedure, however, difficulties have arisen on account of problems with suboptimal materials. We therefore describe a retrograde intubation technique using the knife and stiff plastic introducer from a Mini-Trach II set from Portex Ltd (Kent, UK).METHODS:The cricothyroid membrane was identified and using the knife from the mini-trach set, incised longitudinally. The plastic introducer was inserted through the incision and maneuvered out through the mouth providing a guide over which the endotracheal tube was threaded. The technique was evaluated on 20 cadavers and thereafter used in four patients.RESULTS:Mean intubation time in the 20 cadavers was 6.7 s (range 3-10) from incision to removal of the guide. Also, the technique was used successfully in four patients in whom anterograde attempts failed. In one of these patients the retrograde intubation was life saving.CONCLUSION:Retrograde intubation with a stiff curved plastic introducer was rapid and easy in cadavers and in four patients. In emergency situations where conventional intubation fails it may be life saving.

Occasionally anaesthesiologists find themselves in situations where ventilation during intubation with a fibreoptic bronchoscope (FOB) is desirable. In order to ventilate the patient during the FOB intubation, we used a 90° angle swivel connector, normally used for fibreoptic bronchoscopia in an intubated patient. After a nasotracheal tube is placed with the tip in the oropharynx, ventilation of the patient is possible via this tube by closing the mouth and other nostril. The fibrescopic procedure is done through the right‐angle connector with suction port and the tube is used to guide the tip of the FOB to the aditus laryngis. The method has been used in 7 patients who were impossible to intubate with a conventional procedure. In all patients ventilation was possible and intubation was performed in 5 min (range 1–15).

Anaesthesia with closed anaesthetic systems demands knowledge of the physiology of the patients and of how the various anaesthetic gases behave in the organism as only the gases which the patients produces and absorbs are eliminated and replaced. The system is educational as it provides knowledge of the genuine absorption of oxygen and anaesthetic gases. The method is favourable to the environment as only the gases which are used are supplied and it is thus economical in use although investment in monitoring equipment is necessary. In practice, induction and waking of the patient are complicated with this system and it requires an anaesthetist who constantly adjusts the gases in the circuit.

At present, when economy and environment receive high priority, the ideal anaesthesia system with inhalation anaesthetics is a closed circle system in which only the gases which the patient consumes or produces are replaced or eliminated. Low-flow (LF) anaesthesia in which the fresh gas flow which is employed in a closed system, provides a stable system compares with closed anaesthesia systems. Compared with open systems and circler systems with considerable fresh gas flow, the LF system provides advantages as regards economy, environment and exposure of staff to inhalation anaesthetics. The special conditions involved in LF anaesthesia are described in detail with the hope that the method will obtain more widespread distribution than is the case in Denmark today. If greater safety under anaesthesia is desired, eg by monitoring the concentrations of CO2, O2 and inhalation anaesthetics which the patients inspire and expire, this monitoring equipment can be financed by introduction of LF anaesthesia.