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Emergency gum elastic bougie-assisted tracheal intubation in four patients with upper airway distortion

[L’intubation trachéale d’urgence assistée par une bougie en caoutchouc élastique chez quatre patients qui présentent une distorsion des voies aériennes supérieures]

From the Department of Anesthesia, Hôpital Henri Mondor, Créteil, France.

Address correspondence to: Dr. Xavier Combes, Service d’anesthésie-réanimation, Hôpital Henri-Mondor, 51 avenue du Maréchal de Lattre-de-Tassigny, 94100 Créteil cedex, France. Phone: 33-1-49-81-21-11; Fax: 33-1-49-81-23-34; E-mail: xavier.combes{at}hmn.ap-hop-paris.fr

Purpose: The gum elastic bougie (GEB) has been in use for a long time and allows tracheal intubation in most cases of difficult direct laryngoscopy. Use of the GEB when anatomical landmarks of the upper airway are not recognizable has not been reported. We describe our experience of airway management with the GEB in cases of severe upper airway distortion.

Clinical features: Four patients with severe respiratory distress caused by upper airway distortion secondary to various non-malignant causes were managed with the GEB. For these four patients, a rapid sequence induction of anesthesia was performed with a surgeon present during the procedure. The GEB was used as the initial intubating technique in all cases and allowed a rapid and successful tracheal intubation in spite of non-recognizable anatomical structures. The distal hold-up feeling after GEB insertion confirmed, in all cases, the correct intratracheal position of the GEB.

Conclusion: The GEB can be a valuable tool in cases of difficult airway management caused by upper airway distortion. The lack of visualization of normal pharyngeal structures did not prevent the successful insertion of the GEB in the trachea in the four patients reported.