To shape or not to shape...simulated bougie-assisted difficult intubation in a manikin.
Thirty anaesthetists attempted to place a derived 'optimal' curve bougie or a straight bougie in the trachea of a manikin, in a randomised cross-over study. A Grade 3 Cormack and Lehane laryngoscopic view was simulated. The anaesthetists were blinded to success (tracheal placement) or failure (oesophageal placement). The success rates with the curved and straight bougies were 83 and 7%, respectively, giving a difference (95% confidence interval) of 77% (54-87%) between the two bougies (p < 0.0001). On a separate occasion, under identical laboratory conditions, 30 anaesthetists attempted to place a straight coudé (angled)-tipped bougie or a straight straight-tipped bougie in the trachea of a manikin. The success rates with the coudé- and straight-tipped bougies were 43 and 0%, respectively, giving a difference (95% confidence interval) of 43% (21-61%) between the two bougies (p < 0.001). These results suggest that bougies used to facilitate difficult intubation should be curved and have a coudé tip.
Hodzovic
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Department of Anaesthetics and Intensive Care Medicine, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
Wilkes
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AR
Latto
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IP
D002983:Clinical Competence; D018592:Cross-Over Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D007828:Laryngoscopy; D008348:Manikins; D011364:Professional Practice; D013997:Time Factors