The humble bougie…forty years and still counting?

Intravenous extension lines and the potential for residual drug administration

“…Following recent incidents and warnings on the dangers of residual anaesthetic drugs in intravenous lines [1,2], saline flushing of intravenous connectors has been advocated to avoid the danger [3,4]. However, we would like to draw attention to a problem that may leave residual drugs within multilumen connectors despite proper precautions.…”

“…Advantages over epidural analgesia include a reduction in postoperative opioid consumption, improved patient satisfaction and perhaps reduced length of hospital stay [1]. One wound infiltration catheter system, InfraLong (Pajunk Medizintechnologie GmBH, Geisingen, Germany), includes a novel A B C Figure 5 Injection of iodine solution, as a surrogate for residual drug, demonstrates displacement into other lumens containing air when the cannula is kinked.…”

“…The editorial on the history, development and use of the bougie by Rai [1] provoked a lively discussion in our department on the use of 'clicks' (where the tip of the bougie runs over the tracheal cartilages) and 'hold-up' (where the tip of the bougie encounters the smaller bronchi), prompting a survey of the current clinical practice of anaesthetists.…”

Bougie insertion – the perils of 'click' and 'hold‐up' signs

“…Following recent incidents and warnings on the dangers of residual anaesthetic drugs in intravenous lines [1,2], saline flushing of intravenous connectors has been advocated to avoid the danger [3,4]. However, we would like to draw attention to a problem that may leave residual drugs within multilumen connectors despite proper precautions.…”

A reply

“….day À1 it was never meant to be either an absolute minimum or an absolute maximum [1]. Instead, it was meant to be viewed as a memorable figure to guide approximate prescribing, particularly serving to highlight the inappropriateness of giving a litre or more of 0.9% saline (154 mmol.l…”