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The gum elastic bougie eases tracheal intubation while applying cricoid pressure compared to a stylet

[La bougie flexible, comparée au stylet, facilite l’intubation endotrachéale pendant la compression cricoïdienne]

Takashi Noguchi, MD^*, Kazunori Koga, MD, Yousuke Shiga, MD^* and Akio Shigematsu, MD

^* From the Departments of Anesthesia, Chikuho Rosai Hospital, Kaho-gun;
and the University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.

Address correspondence to: Dr. Kazunori Koga, Department of Anesthesiology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, 807-8555, Japan. Phone: +81-93-691-7265; Fax: +81-93-601-2910; E-mail: kkoga{at}med.uoeh-u.ac.jp

Purpose: To compare the ease of tracheal intubation facilitated by the gum elastic bougie or the malleable stylet while applying cricoid pressure.

Methods: Sixty American Society of Anesthesiologists I–III adult patients undergoing elective surgeries participated in this study. After induction of anesthesia with 2.5 mg•kg^-1 propofol and vecuronium 0.1 mg•kg^-1, the laryngeal view was assessed without and with cricoid pressure. Patients were allocated randomly into two groups: a gum elastic bougie or stylet group. One of the two devices was used for tracheal intubation while applying cricoid pressure. The duration and ease of tracheal intubation was recorded.

Main results: In 58 patients, the trachea was intubated at the first attempt. In the stylet group, tracheal intubation was difficult and needed more time, especially when the glottic opening was not visible. In the bougie group, the duration and ease of intubation was not influenced by laryngeal view. In the remaining two patients with Cook’s modified 3b laryngeal view, it was impossible to intubate the trachea with these devices.

Conclusions: Applying cricoid pressure worsened laryngeal view. The use of a gum elastic bougie was more effective than the use of a stylet to facilitate intubation.

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