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Successful difficult intubation Tracheal tube placement over a gum‐elastic bougie
Author(s) -
Dogra S.,
Falconer R.,
Latto I. P.
Publication year - 1990
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.1990.tb14454.x
Subject(s) - bevel , medicine , intubation , tube (container) , tracheal tube , tracheal intubation , surgery , significant difference , orientation (vector space) , airway management , orthodontics , composite material , structural engineering , mathematics , materials science , geometry , engineering
Summary A randomised study was carried out to assess the effect of tracheal tube rotation on the passage of a tube over a gum‐elastic bougie into the trachea in 100 patients. The effect of the presence or absence of a laryngoscope on successful tube placement was also assessed. A grade 3 difficult intubation was simulated in patients with a laryngoscope. There was a significant difference in the rates for successful first‐time intubation in those patients with tube orientation of ‐90° (with the bevel facing posteriorly) as compared with a tube orientation of 0° (the normal orientation with the bevel facing left). The unsuccessful first‐time intubations with a 0° orientation were frequently converted to successful intubations with the ‐90° position at a second attempt. The presence of a laryngoscope in the mouth while rail‐roading a tube over the bougie also made a significant difference to the rate of successful first‐time intubations. The most successful method was to leave the laryngoscope in the mouth and rotate the tube to ‐90°.