LETTERS TO EDITOR
Year : 2018 | Volume
| Issue : 2 | Page : 373-374
Intubation over a bougie: Nasal is not novel
Ron O Abrons, Randy W Loftus
Department of Anesthesiology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
Dr. Ron O Abrons
Department of Anesthesiology, The University of Iowa Hospitals and Clinics, 6JCP, 200 Hawkins Drive, Iowa City, IA 52242
Source of Support: None, Conflict of Interest: None
|Date of Web Publication||9-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
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. 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. 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. In 2010, Arisaka et al. described the successful use of a similar technique in 16 patients who had failed nasotracheal intubation through conventional methods. In 2008 and 2014, Inoue and Kitano, respectively, described the use of gum-elastic bougies as guides in cases of challenging nasotracheal intubation., In 2013, Staar et al. studied the use of modified Magill forceps for glottic navigation of nasally placed bougies. 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. 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.
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|| |
Cossham PS. Nasotracheal tube placement over a bougie. Anaesthesia 1997;52:184-5.
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.
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.
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.
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.
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.
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.
Abrons RO, Vansickle RA, Ouanes JP. Seldinger technique for nasal intubation: A case series. J Clin Anesth 2016;34:609-11.
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.
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