Does the use of a bougie reduce the force of laryngoscopy in a difficult airway with manual in-line stabilisation?: a randomised crossover simulation study

• Published in: European journal of anaesthesiology Vol. 30; no. 9; p. 563
• Main Authors: Hung, Rachel K Y, Lewinsohn, Asher, Jovaisa, Tomas, Wijayatilake, Dhuleep S, Sherren, Peter B
• Format: Journal Article
• Language: English
• Published: England 01.09.2013
• Subjects: Cross-Over Studies; Humans; Intubation, Intratracheal - methods; Laryngoscopy; Manikins
• ISSN: 1365-2346
• DOI: 10.1097/EJA.0b013e3283631609

Manual in-line stabilisation is usually used during tracheal intubation of trauma patients to minimise movement of the cervical spine and prevent any further neurological injury. Use of a bougie in combination with laryngoscopy may reduce the forces exerted on the cervical spine. To evaluate the difference in force applied to the head and neck during tracheal intubation with a Macintosh laryngoscope with or without simultaneous use of a bougie. Randomised, crossover simulation study. Simulation laboratory, Anaesthetic Department, Queen's Hospital, Romford between March and April 2012. Twenty anaesthetists, all with a minimum of 1 year of anaesthetic experience. Participants used either a Macintosh laryngoscope alone, or in combination with a bougie in a Laerdal SimMan manikin with a simulated difficult airway and manual in-line stabilisation. The force exerted during laryngoscopy. Success rate and time taken to tracheal intubation were also measured. Significantly less force was exerted utilising a Macintosh laryngoscope in combination with a bougie compared with the laryngoscope alone (24.9 versus 44.5 N; P < 0.001). The trachea was successfully intubated on all occasions within 120 s. The use of a bougie was associated with a nonsignificant reduction in the time to tracheal intubation. To minimise the force of laryngoscopy and movement of a potentially unstable cervical spine injury, consideration should be given to the early use of a bougie.