Retrograde intubation in a patient with neglected cervical spine injury for sacral advancement flap

Neglected cervical spine injury is a challenging scenario for an anaesthetist. Fixed deformities,   altered local anatomy, fear of neurological worsening makes intubation difficult and prevents use of manoeuvers in classical intubation. Advances in equipment like fiberoptic bronchoscope or the video laryngoscope aid in such situations. Retrograde intubation (RI) is a useful alternative with high success rate in safe and experienced personnel. The purpose of the article is to highlight the use of this slowly becoming antique technique which becomes quite handy in difficult airway situations.