Management Of A Difficult Airway Assisted By The Use Of A Combination Of Fibreoptic Bronchoscope And Gum Elastic Bougie

Abstract

Both the fibreoptic bronchoscope and the gum-elastic bougie are widely used in the management of a difficult airway [1, 2]. To our knowledge there are no published reports of using these airway tools in combination to change a nasotracheal tube to an orotracheal tube. We report a technique using the combination of a fibreoptic bronchoscope and gum-elastic bougie to change a nasotracheal tube to an orotracheal tube in a morbidly obese patient with a difficult airway. The gum-elastic bougie was guided by the fibrescope alongside the nasotracheal tube and advanced into a left sided small bronchus. Position of the bougie was confirmed by passing the fibreoptic bronchoscope through the nasotracheal tube. The orotracheal tube was then railroaded over the bougie. The rationale for using this technique over other options available in this case is discussed.