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- W2086249476 abstract "To the Editor: We read with interest the article by Weisenberg et al. (1) regarding endotracheal intubation with a gum-elastic bougie (GEB) in unanticipated difficult direct laryngoscopy. The major finding of their article was that, if compared with conventional GEB use (Group 1), the failed intubation rate decreased with the aid of a dental mirror. We would like to raise a few questions concerning the article. First, which type of GEB was used for the study? Two types of GEB are available. Only the angled one (15F × 60 cm, SIMS Portex Ltd., Hythe, UK) is useful for management of difficult airways with the kink being the GEB’s most important feature. Because of its presence, rotating the GEB’s shaft during insertion permits the tip to be “steered” around obstacles, and the GEB can be maneuvered blindly underneath the posterior surface of the epiglottis in case of the Cormack and Lehane’s grade 3 direct laryngoscopy view. On the other hand, the longer straight one (15F × 70 cm) is designed for tracheal tube exchange. Second, were only brand-new GEBs used each time of the study? The manufacturer recommends that the GEB be reused a maximum of five times. But the tip of a used GEB may be no longer in line with the overall curvature (2), so that it may not be possible to advance the bougie behind the epiglottis. The two facts mentioned above should be clearly described because they can have a major influence on the results. Although we admit some possibility of directing a GEB into the esophagus while railroading a tracheal tube over it, our last question is what were the possible causes of the high failure rate with false-positive signs? Contrary to their report (1), tracheal clicks and hold-up are known to be very specific and sensitive signs of the successful placement of a GEB into the trachea (3). Thus, we think that, during the insertion of a GEB for difficult airway management, both signs should be always sought without forceful insertion to excessive depths, which must be followed without delay by capnometric confirmation." @default.
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- W2086249476 date "2003-06-01" @default.
- W2086249476 modified "2023-10-16" @default.
- W2086249476 title "Use of Gum Elastic Bougie During Difficult Airway Management" @default.
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- W2086249476 doi "https://doi.org/10.1213/01.ane.0000063174.15467.e7" @default.
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