Survey of the use of the gum elastic bougie in clinical practice

Abstract

SummaryData were collected prospectively on the use of the gum elastic bougie in 200 patients. The bougie was successfully inserted into the trachea and tracheal intubation was accomplished in 199 cases. The bougie was inserted into the trachea at the ®rst attempt in 178 cases. In nine cases (4.5%) a second, more experienced, clinician was required. In 173 cases, the grades of view were recorded before and after the application of laryngeal pressure; pressure improved the view in 80 cases (46%), had no effect in 89 (51%) and worsened the view in four cases (2%). Various recommendations for optimal external laryngeal pressure and use of the bougie were not followed on 15±64% of occasions. There is a need for better education in these techniques.

Comparison of the Levitan FPS Scope™ and the single‐use bougie for simulated difficult intubation in anaesthetised patients

“…Conceivably, by allowing visual confirmation of intratracheal placement, the LFPS has a major advantage over the bougie insertion, in that the bougie is essentially blind and relies on such clinical signs as hold-up and clicks, which are not 100% reliable [12,32,33]. This confirmation by the LFPS should avoid inadvertent oesophageal intubation.…”

Case reports: Iatrogenic bronchial rupture following the use of endotracheal tube introducers

“…1 They are generally considered safe, but they have occasionally been implicated in iatrogenic airway injury. 2,3 Clinical manifestations of these injuries are minimal, usually blood on the tip at withdrawal or at later tracheal suction. 4 Using computed tomography (CT) imaging, we show two cases of subsegmental bronchial rupture occurring during tracheal intubation using such introducers.…”

Comparison of tracheal introducers

“…We have occasionally encountered a complaint of 'excessive flexibility of the Eschmann' [10]. However, for anaesthetists who like the flexibility of an intact Eschmann, perhaps a 'flexible Frova' could be produced.…”

“…Correct placement of an introducer can be confirmed by three well known signs: 'clicks', 'distal hold up' and coughing [8][9][10]. Other methods are not needed if placement has been confirmed by these signs.…”