Abstract
BackgroundIncidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists.MethodsWe conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression.ResultsThirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization.ConclusionIn this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie.Trial registrationclinicaltrials.gov Identifier: NCT03733158. 7th November 2018.
Highlights
Incidence of difficult endotracheal intubation ranges between 3 and 10%
Ruetzler et al BMC Anesthesiology (2020) 20:90 (Continued from previous page). In this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie
In more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie
Summary
Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. We compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. The estimated incidence of difficult endotracheal intubation ranges between 3 and 10%, depending on the definition used [1, 2]. Unanticipated difficult airway scenarios occur when least expected and significantly lead to anesthesia-related morbidity. The majority of these scenarios arise due to poor visualization of laryngeal inlet - “epiglottis only view” ostensibly due to condition such as pharyngeal obstruction, obesity, limited cervical mobility etc. Situations in which glottic view is expected to improve by external laryngeal manipulation — a readily available airway adjunct device (commonly known as bougie) is recommended to assist tracheal intubation
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