Bougies - or capnography?

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    References1. Paul A, Gibson AA, Robinson ODG, Koch

    J. The traffic light bougie: a study of anovel safety modification. Anaesthesia2014; 69: 2148.

    2. Cook T, Woodall N, Frerk C. Major com-plications of airway management inthe United Kingdom. 4th National AuditProject of the Royal College of Anaes-thetists and the Difficult Airway Society:Report and findings. London: RCoA,March 2011.

    3. Latto IP, Stacey M, Mecklenburgh J,Vaughan RS. Survey of the use of thegum elastic bougie in clinical practice.Anaesthesia 2002; 57: 37984.

    4. Rai MR. The humble bougie. . .fortyyears and still counting? Anaesthesia2014; 69: 199203.

    5. Marson BA, Anderson E, Wilkes AR, Ho-dzovic I. Bougie-related airway trauma:dangers of the hold-up sign. Anaesthe-sia 2014; 69: 21923.

    6. Stone DJ, Bogdonoff DL. Airway consid-erations in the management of patientsrequiring long-term endotracheal intu-bation. Anesthesia and Analgesia 1992;74: 27687.

    7. El-Orbany MI, Salem MR, Joseph NJ. TheEschmann tracheal tube introducer isnot gum, elastic, or a bougie. Anesthesi-ology 2004; 101: 1240.


    Bougies or capnography?

    We read with interest the concerns

    raised about the bougie hold-up

    sign causing airway trauma [1]. The

    use of this sign in determining the

    position of the bougie is superior to

    tracheal clicks alone, as shown by

    Kidd and colleagues [2]. In the arti-

    cle by Paul and colleagues [3], the

    novel use of a traffic light depth

    gauge actively discourages the use

    of hold-up as an endpoint, relying

    solely on clicks. If we are to avoid

    the hold-up sign, then the accuracy

    of bougie positioning may be

    reduced, and perhaps it is time to

    look for another way of confirm-

    ing bougie position. The use of cap-

    nography, as described by Millar

    and colleagues [4], may offer such


    F. A. MillarG. L. HutchisonNinewells HospitalDundee, UKEmail:

    No external funding or competing

    interests declared. Previously posted

    on the Anaesthesia correspondence

    website: www.anaesthesiacorrespon

    References1. Marson BA, Anderson E, Wilkes AR, Ho-

    dzovic I. Bougie-related airway trauma:dangers of the hold-up sign. Anaesthe-sia 2014; 69: 21923.

    2. Kidd JF, Dyson A, Latto IP. Successful dif-ficult intubation. Use of the gum elasticbougie. Anaesthesia 1988; 43: 4378.

    3. Paul A, Gibson AA, Robinson ODG, KochJ. The traffic light bougie: a study of anovel safety modification. Anaesthesia2014; 69: 2148.

    4. Millar FA, Hutchison GL, Glavin R. Gumelastic bougie, capnography and ap-noeic oxygenation. European Journal ofAnaesthesiology 2001; 18: 513.


    Preloading bougies

    We read with interest the report of

    airway trauma related to the use of

    gum-elastic bougies during airway

    management [1]. The accompany-

    ing editorial succinctly summarises

    the past, present and possible future

    of the humble bougie [2].

    In our bariatric anaesthesia

    practice, we have found wide use

    for the bougie and often use it elec-

    tively in super-morbidly obese

    patients. The bougie is very useful

    when there is an occlusive prolifera-

    tion of oropharyngeal soft tissues,

    as seen in obstructive sleep apnoea

    and obesity, keeping the time to

    tracheal intubation as short as

    possible and avoiding having to

    implement a rescue Plan B [3].

    We have developed a simple

    innovation for use of the bougie in

    bariatric anaesthesia (that may be

    applicable to other situations), the

    Preloaded Bougie Technique, in

    which the bougie is electively pre-

    loaded into the tracheal tube and

    held in place by the pilot balloon

    (Fig. 1). After induction of anaes-

    thesia and under direct laryngos-

    copy, the anaesthetist holds the

    bougie and inserts its curved distal

    Figure 1 Preloaded bougie.

    2014 The Association of Anaesthetists of Great Britain and Ireland 515

    Correspondence Anaesthesia 2014, 69, 511526