Comparison of laryngeal morbidities with modified reinforced silicone tube intubation guided over a bougie vs. a guidewire: novel assessment with voice analysis

Abstract

Semi-rigid flexible introducer-guided tracheal intubation is associated with pharyngolaryngeal morbidities. We compared the practice of railroading a newly described modified reinforced silicone tracheal tube with a built-in guide channel in its wall over a non-kinking guidewire with railroading the same tube over a disposable bougie, with respect to pharyngolaryngeal morbidities. One hundred and twenty-four ASA 1 and 2 adults were randomly assigned to undergo bougie-guided (n = 62) or wire-guided (n = 62) intubation under general anaesthesia. All patients were assessed for postoperative pharyngolaryngeal complaints. In addition, voice parameters (fundamental frequency, shimmer, jitter and harmonic noise ratio) with vowels 'a' and 'i' were analysed pre-operatively and 24 h postoperatively. The success of first-attempt intubation and the associated haemodynamic response were also recorded. A higher incidence of pharyngolaryngeal complaints was seen in the bougie group, 48.3%, 95%CI (35.9-60.9%) when compared with wire-guided group 28.3%, 95%CI (18.0-40.6%), p = 0.01. Postoperatively, all the voice parameters were significantly more affected when compared with their pre-operative value in the bougie-guided group (p < 0.05) but not in the wire-guided group. The success of first-attempt intubation was similar in both groups. Wire-guided orotracheal intubation was associated with a lower incidence of pharyngolaryngeal complaints and effect on voice when compared with bougie-guided intubation.

Bougie vs. guidewire for tracheal intubation

“…Ponnusamy et al. reported a lower incidence of pharyngolaryngeal complaints associated with wire‐guided orotracheal intubation compared with using bougie‐guided intubation (28.3% vs. 48.3% for wire‐guided and bougie group, respectively; p = 0.01) . The finding is compatible with that of a previous study demonstrating possible impingement on laryngeal structures due to the large gaps in diameter between the introducer and the tracheal tube .…”

“…Despite the lack of significant difference in the first attempt intubation rate (95% vs. 93.3%) and relatively minor laryngeal trauma limited to grade 1 (i.e. mild abrasion in glottis or subglottis and mild vocal fold oedema) in both groups , the bougie‐guided group had a significantly higher incidence of pharyngolaryngeal. This finding seems especially paradoxical after taking into consideration that there were more patients with pharyngolaryngeal complaints than those with grade‐1 laryngeal trauma in each group (Table 2 ).…”

“…mild abrasion in glottis or subglottis and mild vocal fold oedema) in both groups , the bougie‐guided group had a significantly higher incidence of pharyngolaryngeal. This finding seems especially paradoxical after taking into consideration that there were more patients with pharyngolaryngeal complaints than those with grade‐1 laryngeal trauma in each group (Table 2 ). Therefore, the laryngeal trauma score appears to be unrelated to the incidence of pharyngolaryngeal complaints that occurred even in patients without notable laryngeal trauma (i.e.…”

“…Accordingly, the study by Ponnusamy et al. utilised a modified reinforced silicone tracheal tube with a built‐in guide channel to overcome this problem by using the guidewire technique. Although the findings in that study may provide significant insights into the improvement of patient safety, some important issues need to be clarified.…”

Subglottic airway injury caused by difficult tracheal tube passage

“…Since discrepancy exists between the grading of laryngeal trauma and clinical symptoms (e.g. sore throat, hoarseness) for airway procedures , it remains unclear whether the BlockBuster tube actually produces the best airway outcomes compared with the other two tubes, as relevant information regarding injuries other than those to the tracheal mucosa was not available.…”