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Table of Contents
CORRESPONDENCE
Year : 2011  |  Volume : 27  |  Issue : 1  |  Page : 129-130

Indigenous bougie for unanticipated difficult airway


1 Saroj Hospital and Heart Institute, Delhi, India
2 Maulana Azad Medical College, Delhi, India

Date of Web Publication11-Feb-2011

Correspondence Address:
Anshu Gupta
Maulana Azad Medical College, Delhi
India
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Source of Support: None, Conflict of Interest: None


PMID: 21804730

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How to cite this article:
Gupta V, Gupta A, Gupta A. Indigenous bougie for unanticipated difficult airway. J Anaesthesiol Clin Pharmacol 2011;27:129-30

How to cite this URL:
Gupta V, Gupta A, Gupta A. Indigenous bougie for unanticipated difficult airway. J Anaesthesiol Clin Pharmacol [serial online] 2011 [cited 2020 Jul 15];27:129-30. Available from: http://www.joacp.org/text.asp?2011/27/1/129/76674

Dear Sir,

Difficult airways have always been a challenge for the anesthesiologists with reported incidence of unanticipated difficult intubation as high as 4.9 percent. [1] In such scenarios, bougie has been an invaluable tool to guide intubation. It being inexpensive, simple, easy to use has been suggested by various difficult airway guidelines. Although, commonly used, is associated with certain disadvantages and complications.

Currently, several types of introducers are called bougie which include disposable (single use), re-usable (multiple use) and homemade. The commonly used gum elastic bougie (GEB) is the angled one (15F X 60cm) which is useful for management of difficult airways.

We have indigenously designed bougie using nasogastric tube and 22G stainless steel coiled spring wire. The wire is placed inside the nasogastric tube till 60cm and distal end of tube is cut and soldered. Angulation is made at the proximal end by kinking the coiled wire [Figure 1],[Figure 2].
Figure 1 :Indigenous bougie made out of coiled spring wire

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Figure 2 :Comparison of Indigenous bougie with the conventional one.

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This indigenously made bougie has multifold advantages over gum elastic bougie and homemade introducer. It is cheap and in the developing countries, where cost of medical treatment is the major factor, this indigenously made bougie can be of immense help to the anesthetist. It is and can be used multiple times while the GEB can be reused to a maximum of five times. [2] Frequent use of GEB beyond the recommended times may cause misalignment of the tip with overall curvature and rigidity, making intubation difficult. Furthermore, there are reports of detachment of tip of the bougie during intubation due to parching and subsequent weakness of the material with repeated usage. [3] There are traumatic complications of bleeding in airway, esophageal laceration and pneumothorax with usage of bougie. [4] All these complications of gum elastic bougie are circumvented by our indigenous bougie. With coiled spring wire inside the nasogastric tube, the chances of detachment of tip as with GEB are minimal. The smooth tip of nasogastric tube also makes it much less traumatic. The spring wire provides the requisite flexibility and rigidity helping in difficult intubation. Our innovative bougie can be sterilized either using glutaraldehyde or ethylene oxide any number of times.

Nasogastric tube has been used earlier as a part of lighted stylet using laryngoscope bulb. [5] But, it has the disadvantage of bulb dislocation. Moreover, bougie in unanticipated difficult airway is superior to the lighted stylet since it is easier to manipulate and does not require expert training.

The homemade introducer had been previously used using 60cm piece of cord introducer similar to electric cord made up of nylon. It was cut and its extremities were sanded to make it less traumatizing. Still, it has the disadvantage of having coarse extremities and projections, which are potential sources of traumatism. Moreover, it was difficult to achieve an appropriate angulation to negotiate through epiglottis.

In conclusion, use of bougie in unanticipated difficult airway as an effective, easy and safe tool has been widely advocated. Our innovative bougie can be an effective alternative to the commercially available bougie having the advantage of being less costly, less traumatic and associated with fewer complications with repeated usage and can be sterilized.

 
   References Top

1.Kanaya N, Kawana S, Watanabe H, Niiyama Y, Niiya T, Nakayama M, Namiki A. The Utility of Three-Dimensional Computed Tomography in Unanticipated Difficult Endotracheal Intubation. Anesth Analg 2000; 91: 752-4.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Latto P. Fracture of the outer varnish layer of a gum elastic bougie. Anaesthesia 1999; 54: 497-8.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Gardner M, Janokwski S. Detachment of the tip of a gum-elastic bougie. Anaesthesia 2002; 57: 88-9.  Back to cited text no. 3
[PUBMED]    
4.Hodzovic I, Latto IP, Henderson JJ. Bougie trauma - what trauma? Anaesthesia 2003; 58: 192-3.  Back to cited text no. 4
[PUBMED]    
5.Jain M, Garg M, Agarwal V, Akhtar S. Lighted Stylet for Difficult Intubation: An Innovation. J Anaesth Clin Pharmacol 2007; 23: 191-3.  Back to cited text no. 5
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    Figures

  [Figure 1], [Figure 2]



 

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