Lessons learnt from a difficult intubation scenario: Videolaryngoscopes cannot replace the humble bougie

Abstract

With the advent of videolaryngoscopes, the incidence of difficult intubation has decreased. Videolaryngoscopes are slowly replacing other airway gadgets such as the fibreoptic bronchoscope and intubating supraglottic devices, especially in institutions where they are freely available. These could not only be the first choice in anticipated difficult intubation but also the first rescue device in unanticipated difficult intubations. A failed intubation can occur despite obtaining a good view of the glottis with a videolaryngoscope. We were unable to intubate an anticipated difficult airway with C-MAC D-blade with a preformed hockey stick-shaped tube using a stylet despite using manoeuvres to optimise laryngeal view. The patient was finally intubated over a gum elastic bougie passed when retaining the videolaryngoscope in place. This case report highlights that a simple gum elastic bougie holds an equally important place on the difficult airway cart as a videolaryngoscope. The use of a gum elastic bougie should be considered as important as a videolaryngoscope in a difficult intubation scenario. It is reasonable to attempt the use of a bougie in the case of failed videolaryngoscope-assisted intubation before switching to another intubating device or a supraglottic airway. A dental consult for poor dentition should be taken prior to surgery whenever possible. Control of bleeding from a broken tooth needs to be done simultaneously and expeditiously even when we have visualised the glottis and are anticipating a successful intubation.