Macklin effect as potential responsible complication after retrograde intubation: a case report.

Retrograde intubation is currently part of the Difficult Airway Algorithm of the American Society of Anesthesiologists, and as such, every anesthesiologist should be competent in this procedure. Nevertheless, when performing it, one must be aware that it is not exempt of complications. We review the case of a patient who, after being intubated using this technique, developed signs and symptoms compatible with the Macklin effect. Macklin effect involves a three-step pathophysiologic process: blunt traumatic alveolar rupture, air dissection along bronchovascular sheaths, and spreading of this blunt pulmonary interstitial emphysema into the mediastinum.