• E Boufflers, V Hannebicque, M Niset, H Reyford, and R Krivosic-Horber.
• Département d'Anesthésie-Réanimation Chirurgicale I, Hôpital B, Centre Hospitalier Régional, Lille.
• Ann Fr Anesth Reanim. 1990 Jan 1;9(1):67-74.

AbstractNumerous anaesthetic techniques exist for a patient who presents with a difficult endotracheal intubation. They all require an anaesthetic protocol which cannot be improvised. When intubation is expected to be difficult at the pre-anaesthetic examination, the use of a fiberoptic bronchoscope is the technique of choice for intubating adults under local anaesthesia, and children under general anaesthesia. When a fiberoptic bronchoscope is not available, several alternatives can be suggested: local anaesthesia of the glottis, retro-molar and retrograde intubation, or the use of a guide threaded over a lighted stylet; these techniques can be used in an anaesthetized patient breathing spontaneously. In the paralyzed patient impossible to intubate, various trans-laryngeal techniques of ventilation can be used in emergency: jet ventilation via the trans-crico-thyroid route, the use of a cricotomy cannula, or a minitracheotomy set.

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