Nasotracheal intubation over a bougie vs. non‐bougie intubation: a prospective randomised, controlled trial in older children and adults using videolaryngoscopy

Nasotracheal intubation over a bougie vs. non‐bougie intubation: a prospective randomised, controlled trial in older children and adults using videolaryngoscopy*

First published: 15 September 2017
Cited by: 4

*Presented in part at the Society for Airway Management Annual Meeting, Atlanta, Georgia, USA, September 2016

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Conventionally, nasotracheal intubation has consisted of blind nasal passage and external manipulation of the tube through the glottis (‘conventional technique’), a technique associated with a high incidence of nasal trauma. We evaluated a novel technique for routine asleep (i.e. post‐induction) nasotracheal intubation using a bougie (‘bougie technique’), which uses a nasopharyngeal airway to guide a paediatric bougie nasotracheally for use as a Seldinger tracheal intubation guide. Two hundred and fifty‐seven older children (> 8 years) and adults were randomly assigned to videolaryngoscopy‐assisted nasotracheal intubation using either the conventional or the bougie technique. The hypothesis was that the bougie technique would result in less nasopharyngeal trauma. The bougie technique was associated with significantly less nasopharyngeal bleeding than the conventional technique at both 60–90 s (55% vs. 68%; p = 0.033) and 5 min (51% vs. 70%; p = 0.002). The severity of bleeding was also significantly less with the bougie technique, with an OR for active bleeding of 0.42 (95%CI 0.20–0.87; p = 0.020) at 60–90 s and 0.15 (95%CI 0.06–0.37; p < 0.0001) at 5 min. Magill forceps were needed significantly less often with the bougie technique (9% vs. 28%, p = 0.0001) and there was no difference in first attempt and overall success rates between the two techniques (p = 0.133 and p = 0.750, respectively). Not only is nasal intubation over a bougie as successful as the conventional technique, it also significantly decreases both the incidence and severity of nasopharyngeal trauma, as well as the need for the use of Magill forceps.



A Simulator Study of Tube Exchange with Three D… [Anesth Analg. 2014] – PubMed – NCBI

Anesth Analg. 2014 May 15. [Epub ahead of print]

A Simulator Study of Tube Exchange with Three Different Designs of Double-Lumen Tubes.



We sought to determine whether the design of 3 different double-lumen endobronchial tubes (DLT) (Rusch, Mallinckrodt, Fuji) has an effect on the ease of placement over an airway exchange catheter (AEC) using a video laryngoscope.


A convenience sample of 17 anesthesia residents and fellows with at least 3 years of anesthesia training was recruited from teaching hospitals in Toronto for a randomized crossover trial. Each participant passed each DLT over an AEC in an airway simulator, visualized and video recorded via a video laryngoscope (GlideScope). The order of exchange was randomized by blindly pulling the name of the manufacturer of a DLT from a box. The primary outcome was time to intubate, defined as time from the bronchial lumen entering the GlideScope view to the bronchial lumen passing the vocal cords. Also recorded were participants’ subjective rating of the ease of use and failure rate, defined as an attempt >150-second duration.


Time to intubate was faster with the Fuji-Phycon DLT (median 2 seconds) compared with both the Rusch (median 27 seconds, P = 0.0144) and Mallinckrodt (median 21 seconds, P = 0.0117). On a scale of 1 to 10, with 10 being very easy to use and 1 being very difficult, the Fuji-Phycon was judged to be easier to use (median 10 seconds) compared with the Rusch (median 3, P = 0.0186) and the Mallinckrodt (median 4 seconds, P = 0.0123). The Rusch was associated with significantly more failures than the other DLTs, P = 0.002.


The Fuji-Phycon DLT was easier to pass over an AEC in this simulator trial and warrants consideration in patients with difficult airways who require 1-lung ventilation.