Rigid bronchoscope-assisted endotracheal intubation: Yet another use of the
gum elastic bougie.
A limitation to use a
gum elastic bougie through Murphy's eye for difficult intubation-reply
Outright failure of insertion occurred in one child (age four months, weight 8 kg) in whom insertion failed despite attempts using the metal introducer and 'railroading' the PLMA over a
gum elastic bougie.
After blind passage of a
gum elastic bougie into the trachea, an 8 mm Mallinckrodt endotracheal tube was railroaded over the bougie and rotated 90[degrees] anticlockwise before passing through the vocal cords.
Recently,
Gum Elastic Bougie (GEB) guided PLMA insertion has been described (1,2), which avoids impaction at the back of the mouth.
The term "
gum elastic bougie" has been recurring in anaesthetic literature ever since Professor Robert Macintosh was apparently experimenting with the development of the right-angled Oxford endotracheal tube and wrote a short, illustrated article in the British Medical Journal on January 1, 1949 (1).
Possible solutions include inserting the ETT in a horizontal plane and rotating it back to the vertical once it has passed the flange of the GlideScope[R] (2), using a
gum elastic bougie as an introducer (5), or inserting the ETT first and advancing it past the base of the tongue before inserting the GlideScope[R].