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. 2015:2015:617805.
doi: 10.1155/2015/617805. Epub 2015 Oct 1.

Utility of a gum-elastic bougie for difficult airway management in infants: a simulation-based crossover analysis

Nobuyasu Komasawa  1 , Akira Hyoda  1 , Sayuri Matsunami  1 , Nozomi Majima  1 , Toshiaki Minami  1
Affiliations

Utility of a gum-elastic bougie for difficult airway management in infants: a simulation-based crossover analysis

Nobuyasu Komasawa et al. Biomed Res Int. 2015.

Abstract

Background: Direct laryngoscopy with the Miller laryngoscope (Mil) for infant tracheal intubation is often difficult to use even for skilled professionals. We performed a simulation trial evaluating the utility of a tracheal tube introducer (gum-elastic bougie (GEB)) in a simulated, difficult infant airway model.

Methods: Fifteen anesthesiologists performed tracheal intubation on an infant manikin at three different degrees of difficulty (normal [Cormack-Lehane grades (Cormack) 1-2], cervical stabilization [Cormack 2-3], and anteflexion [Cormack 3-4]) with or without a GEB, intubation success rate, and intubation time.

Results: In the normal and cervical stabilization trials, all intubation attempts were successful regardless of whether or not the GEB was used. In contrast, only one participant succeeded in tracheal intubation without the GEB in the anteflexion trial; the success rate significantly improved with the GEB (P = 0.005). Intubation time did not significantly change under the normal trial with or without the GEB (without, 12.7 ± 3.8 seconds; with, 13.4 ± 3.6 seconds) but was significantly shorter in the cervical stabilization and anteflexion trials with the GEB.

Conclusion: GEB use shortened the intubation time and improved the success rate of difficult infant tracheal intubation by anesthesiologists in simulations.

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Figures

Figure 1
Figure 1
Gum-elastic bougie and manikins used in the study. (a) 5 Fr gum-elastic bougie, (b) ALS Baby Trainer manikin for the normal trial, (c) ALS Baby Trainer manikin for the cervical stabilization trial, and (d) ALS Baby Trainer manikin for the anteflexion trial.
Figure 2
Figure 2
Intubation time with and without the gum-elastic bougie. White box: without GEB; black box: with GEB. Results are expressed as mean ± SD and were analyzed by two-way analysis of variance. NS: no significant difference; ∗ P < 0.05 compared to without GEB.
Figure 3
Figure 3
Visual analog scale for simulated tracheal intubation with and without gum-elastic bougie. (a) Laryngoscopic imaging and (b) tube passage through the glottis. White box: without GEB; black box: with GEB. Results are expressed as mean ± SD and were analyzed by two-way analysis of variance. NS: no significant difference; ∗ P < 0.05 compared to without GEB.
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