title: Does the use of a bougie reduce the force of laryngoscopy in a difficult airway with manual in-line stabilisation?: a randomised crossover simulation study.
abstract: BACKGROUND
  Manual in-line stabilisation is usually used during tracheal intubation of trauma patients to minimise movement of the cervical spine and prevent any further neurological injury. Use of a bougie in combination with laryngoscopy may reduce the forces exerted on the cervical spine.
  
  
  OBJECTIVE
  To evaluate the difference in force applied to the head and neck during tracheal intubation with a Macintosh laryngoscope with or without simultaneous use of a bougie.
  
  
  METHODS
  Randomised, crossover simulation study.
  
  
  METHODS
  Simulation laboratory, Anaesthetic Department, Queen's Hospital, Romford between March and April 2012.
  
  
  METHODS
  Twenty anaesthetists, all with a minimum of 1 year of anaesthetic experience.
  
  
  METHODS
  Participants used either a Macintosh laryngoscope alone, or in combination with a bougie in a Laerdal SimMan manikin with a simulated difficult airway and manual in-line stabilisation.
  
  
  METHODS
  The force exerted during laryngoscopy. Success rate and time taken to tracheal intubation were also measured.
  
  
  RESULTS
  Significantly less force was exerted utilising a Macintosh laryngoscope in combination with a bougie compared with the laryngoscope alone (24.9 versus 44.5 N; P < 0.001). The trachea was successfully intubated on all occasions within 120 s. The use of a bougie was associated with a nonsignificant reduction in the time to tracheal intubation.
  
  
  CONCLUSIONS
  To minimise the force of laryngoscopy and movement of a potentially unstable cervical spine injury, consideration should be given to the early use of a bougie.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Queen's Hospital, Romford, UK. rachelhky@gmail.com
authors.forename: Rachel K Y
authors.initials: RK
authors.lastname: Hung
authors.forename: Asher
authors.initials: A
authors.lastname: Lewinsohn
authors.forename: Tomas
authors.initials: T
authors.lastname: Jovaisa
authors.forename: Dhuleep S
authors.initials: DS
authors.lastname: Wijayatilake
authors.forename: Peter B
authors.initials: PB
authors.lastname: Sherren
mesh_terms: D018592:Cross-Over Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy; D008348:Manikins