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Correspondence |
St. John’s, Newfoundland
To the Editor:
Noguchi et al.1 purport to "... show the clear superiority of a gum elastic bougie to a stylet for tracheal intubation during application of cricoid pressure." Their admittedly subjective conclusion is contradicted by their objective data in Table III, which indicates that the stylet technique is faster with an easy than with a restricted laryngoscopic view, and that it is as good as or better than the bougie technique, which is equally slow with an easy or restricted view.
My experience compares a one-handed stylet technique (described by Stasiuk)2 to that of the authors, redefining the times to highlight rather than blur differences: T1 (mask removal to best visualization) both 6 sec; T2 (visual placement of endotracheal tube) stylet 4 sec, bougie 11 sec; T3 (placement to circuit attachment) stylet 6 sec, bougie 8 sec; T4 (attachment to positive capnogram) both 3 sec; Total time (sum) stylet 19 sec, bougie 28 sec; airway grades 1, 2a, 2b, 3a, with and without cricoid pressure. Placement time (T2) is more than twice as long with the bougie because more steps are required.
Due to speed, simplicity, and freeing up the helper’s hands, the one handed stylet technique has been my first choice for years without any failures in grade 1 to 3a airways. Not only is my conclusion the opposite of the authors, their objective data do not support their conclusion.
References
1 Noguchi T, Koga K, Shiga Y, Shigematsu A. The gum elastic bougie eases tracheal intubation while applying cricoid pressure compared to a stylet. Can J Anesth 2003; 50: 712–7.
2 Stasiuk RB. Improving styletted oral tracheal intubation: rational use of the OTSU. Can J Anesth 2001; 48: 911–8.
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