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Open Access 01-12-2020 | Difficult Airway | Research article

Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial

Authors: Kurt Ruetzler, Jacek Smereka, Cristian Abelairas-Gomez, Michael Frass, Marek Dabrowski, Szymon Bialka, Hanna Misiolek, Tadeusz Plusa, Oliver Robak, Olga Aniolek, Jerzy Robert Ladny, Damian Gorczyca, Sanchit Ahuja, Lukasz Szarpak

Published in: BMC Anesthesiology | Issue 1/2020

Abstract

Background

Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists.

Methods

We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression.

Results

Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization.

Conclusion

In this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie.

Trial registration

clinicaltrials.gov Identifier: NCT03733158. 7th November 2018.

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Title: Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial
Authors: Kurt Ruetzler
Jacek Smereka
Cristian Abelairas-Gomez
Michael Frass
Marek Dabrowski
Szymon Bialka
Hanna Misiolek
Tadeusz Plusa
Oliver Robak
Olga Aniolek
Jerzy Robert Ladny
Damian Gorczyca
Sanchit Ahuja
Lukasz Szarpak
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Difficult Airway
Airway Management
Published in: BMC Anesthesiology / Issue 1/2020
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-020-01009-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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