The Bougie or "Tactile Stylet", a useful classic alternative in modern intubation. Regarding a clinical case in the Hospital Universitario Nacional de Colombia
The gum elastic bougie or Eschmann stylet is a tool designed to guide intra-tracheal intubation that is underutilised in our setting, despite scientific information confirming that it is highly useful in difficult intubation. This case report describes the clinical use of a simple and practical device that is seldom used on our setting, especially in patients with difficult airways.
The case presented is that of a 63-year-old female patient with a history of rheumatoid arthritis and diagnosed with abcesses in the elbow and gluteal region requiring surgical drainage. After the induction of general anesthesia, when laryngoscopy with a conventional laryngoscope was attempted, it was impossible to visualise any of the laryngeal structure (Cormack IV). With the help of the bougie, tracheal intubation was possible on first attempt.
The bougie is a highly useful tool in cases of difficult intubation in anesthesiology services and intensive or emergency care units. However, its use is still not widespread in our setting.
The bougie or "tactile stylet" is a low-cost, easy-to-use device that is useful as a first choice in the management of anticipated and unanticipated difficult airways.
2. Kidd JF, Dyson A, Latto IP. Successful difficult intubation. Use of the gum elastic bougie. Anaesthesia. 1988;43:437-8.
3. Henderson JJ. Development of the gum elastic bougie. Anaesthesia. 2003;58:103-4.
4. El-Orbany MI, Salem MR, Joseph NJ. The Eschmann tracheal tube introducer is not gum, elastic or a bougie. Anesthesiology. 2004;101:1240.
5. McCarroll SM, Lamont BJ, Buckland MR, Yates AP. The gum-elastic bougie: old but still useful. Anesthesiology. 1988;68:643-4.
6. Venn PH. The gum elastic bougie. Anaesthesia. 1993;48:274-5.
7. Ray MR. Editorial. The humble bougie... forty years and still counting? Anesthesia. 2014;69:199-203.
8. Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia. 2004;59:675-94.
9. Brazil V, Grobler C, Greenslade J, Burke J. Comparison of intubation performance by junio emergency department doctors using gum elastic bougie versus stylet reinforced endotracheal tube insertion techniques. Emerg Med Australasia. 2012;24:194-200.
10. Niven AS, Doerschug KC. Techniques for the difficult airway. Curr Opin Crit Care. 2013;19:9-15.
11. Koay CK. Difficult tracheal intubation analysis and management in 37 cases. Singapore Med J. 1998;39:112-4.
12. Detav M, Shiniara M, Leborgne JM. Use of Eschmanns gum elastic bougie in difficult orotracheal intubation, an audit over eight years of clinical practice. Ann Fr Anesth Reanim. 2008;27:154-7.
13. Morton T, Brady S, Clancy M. Difficult airway management in English emergency departments. Anaesthesia. 2000;55:485-8.
14. Latto IP, Stacey M, Mecklenburgh J, Vaughan RS. Survey of the use of the gum elastic bougie in clinical practice. Anaesthesia. 2002;57:379-84.
15. Kadry M, Popat M. Pharyngeal wall perforation - an unusual complication of blind intubation with gum elastic bougie. Anaesthesia. 1999;54:404-5.
16. Jabre PCombes X, Bertrand L, Aaron E, Auger H, Margenet A, et al. Use of gum elastic bougie for prehospital difficult intubation. Am J Emerg Med. 2005;23:552-5.
17. Bougie port video laryngoscope intubation. Copilot VL.com. Available from: https://goo.gl/XiXtpD [accessed 20.12.16].
18. Moscati R, Jehle D, Christiansen G, D'Aprix T, Radford J, Connery C, et al. Endotracheal tube introducer for failed intubations: a variant of the gum elastic bougie. Ann Emerg Med. 2000;36:52-6.
19. Gataure PS, Vaughan RS, Latto IP. Simulated difficult intubation. Comparison of the gum elastic bougie and the stylet. Anaesthesia. 1996;51:935-8.
20. Nocera A. A flexible solution for emergency intubation difficulties. Ann Emerg Med. 1996;27:665-7.
21. Butler KH, Clyne B. Management of the difficult airway: alternative airway techniques and adjuncts. Emerg Med Clin North Am. 2003;21:259-89.
22. Dogra S, Falconer R, Latto IP Successful difficult intubation tracheal tube placement over a gum-elastic bougie. Anaesthesia. 1990;45:774-6.
23. Cossham PS. Difficult intubation. Br J Anaesth. 1985;57:239.
24. Nolan JP, Wilson ME. Orotracheal intubation in patient with potential cervical spine injuries. Anaesthesia. 1993;48:630-3.
25. Whitten C. The bougie: use wisely to avoid rare but serious complications. Junio. 2015. Available from: https://goo.gl/4otU1t [accessed 08.12.16].
26. Levack ID, Masson AHB. Difficult tracheal intubation. Anaesthesia. 1986;41:332.
27. Shah KH, Kwong BM, Hazan A, Newman DH, Wiener D. Success of the gum elastic bougie as a rescue airway in the emergency department. J Emerg Med. 2011;40:1-6.
The publisher (Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E.) retains copyright for the published articles.
Creative Commons License
Articles published by Colombian Journal of Anesthesiology are licensed under the Creative Commons 4.0 license: Attribution-NonCommercial-NoDerivs: CC BY-NC-ND.