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Year : 2018  |  Volume : 12  |  Issue : 2  |  Page : 373-374

Intubation over a bougie: Nasal is not novel

Department of Anesthesiology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA

Correspondence Address:
Dr. Ron O Abrons
Department of Anesthesiology, The University of Iowa Hospitals and Clinics, 6JCP, 200 Hawkins Drive, Iowa City, IA 52242
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sja.SJA_779_17

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Date of Web Publication9-Mar-2018

How to cite this article:
Abrons RO, Loftus RW. Intubation over a bougie: Nasal is not novel. Saudi J Anaesth 2018;12:373-4

How to cite this URL:
Abrons RO, Loftus RW. Intubation over a bougie: Nasal is not novel. Saudi J Anaesth [serial online] 2018 [cited 2020 Jul 9];12:373-4. Available from:

Dear Sir,

We are writing in regards to a case series in the October-December issue titled “Gum elastic bougie as a guide in nasotracheal intubation: A novel technique.” The authors described five cases in which difficult passage of a nasotracheal tube was overcome by the use of a nasally placed bougie as part of a Seldinger-based technique. Bhat Pai et al. correctly point out that the use of an airway bougie can facilitate nasotracheal intubation in a variety of difficult clinical scenarios. The suggestion that this is a novel technique, though, is of question.

As early as 1997, Cossham described the routine use of bougies in nasotracheal intubation.[1] In 2006, Arora et al. presented a series of three pediatric cases in which a gum-elastic bougie was used to facilitate blind nasotracheal intubation in children.[2] Also in 2006, Morimoto et al. described the use of a curve-tipped suction catheter as a guide for nasotracheal intubation, showing a significant decrease in nasal bleeding with the technique.[3] In 2010, Arisaka et al. described the successful use of a similar technique in 16 patients who had failed nasotracheal intubation through conventional methods.[4] In 2008 and 2014, Inoue and Kitano, respectively, described the use of gum-elastic bougies as guides in cases of challenging nasotracheal intubation.[5],[6] In 2013, Staar et al. studied the use of modified Magill forceps for glottic navigation of nasally placed bougies.[7] In 2015, Abrons et al. presented a case series in which pediatric bougies, guided by nasal trumpets, were utilized as guides for successful nasal intubation under challenging conditions.[8] In 2017, Abrons et al. prospectively studied this technique of nasotracheal intubation over a bougie passed through a nasopharyngeal airway in 257 patients, showing a significant decrease in both the incidence and severity of nasal trauma, with less need for Magill forceps, than with the conventional technique of blind nasal passage and external tube manipulation.[9]

The above literature outlines the increasing knowledge of, and experience with, nasotracheal intubation over bougies. With this evidence-based foundation, the goal of achieving atraumatic nasal intubation inches closer. While the contribution of Bhat Pai et al. to the lexicon is appreciated, the above-cited works clearly show that the suggestion of novelty is questionable.

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  References Top

Cossham PS. Nasotracheal tube placement over a bougie. Anaesthesia 1997;52:184-5.  Back to cited text no. 1
Arora MK, Karamchandani K, Trikha A. Use of a gum elastic bougie to facilitate blind nasotracheal intubation in children: A series of three cases. Anaesthesia 2006;61:291-4.  Back to cited text no. 2
Morimoto Y, Sugimura M, Hirose Y, Taki K, Niwa H. Nasotracheal intubation under curve-tipped suction catheter guidance reduces epistaxis. Can J Anaesth 2006;53:295-8.  Back to cited text no. 3
Arisaka H, Sakuraba S, Furuya M, Higuchi K, Yui H, Kiyama S, et al. Application of gum elastic bougie to nasal intubation. Anesth Prog 2010;57:112-3.  Back to cited text no. 4
Inoue H, Saito T, Kamishima K, Okano T, Kuno Y, Arai T, et al. Successful nasal intubation using airway scope with gum elastic bougie in a case of difficult airway. Masui 2008;57:457-9.  Back to cited text no. 5
Kitano M, Komasawa N, Nakahira J, Fujiwara S, Tatsumi S, Minami T, et al. Successful nasotracheal intubation with the PENTAX-AWS AirwayScope and gum-elastic bougie in a patient with recurrent tongue cancer. Masui 2014;63:409-11.  Back to cited text no. 6
Staar S, Biesler I, Müller D, Pförtner R, Mohr C, Groeben H, et al. Nasotracheal intubation with three indirect laryngoscopes assisted by standard or modified Magill forceps. Anaesthesia 2013;68:467-71.  Back to cited text no. 7
Abrons RO, Vansickle RA, Ouanes JP. Seldinger technique for nasal intubation: A case series. J Clin Anesth 2016;34:609-11.  Back to cited text no. 8
Abrons RO, Zimmerman MB, El-Hattab YM. Nasotracheal intubation over a bougie vs. non-bougie intubation: A prospective randomised, controlled trial in older children and adults using videolaryngoscopy. Anaesthesia 2017;72:1491-500.  Back to cited text no. 9


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