Does the use of a bougie reduce the force of laryngoscopy in a difficult airway with manual in-line stabilisation?: a randomised crossover simulation study.

CONTEXT

Manual in-line stabilisation is usually used during tracheal intubation of trauma patients to minimise movement of the cervical spine and prevent any further neurological injury. Use of a bougie in combination with laryngoscopy may reduce the forces exerted on the cervical spine.

OBJECTIVE

To evaluate the difference in force applied to the head and neck during tracheal intubation with a Macintosh laryngoscope with or without simultaneous use of a bougie.

DESIGN

Randomised, crossover simulation study.

SETTING

Simulation laboratory, Anaesthetic Department, Queen's Hospital, Romford between March and April 2012.

PARTICIPANTS

Twenty anaesthetists, all with a minimum of 1 year of anaesthetic experience.

INTERVENTIONS

Participants used either a Macintosh laryngoscope alone, or in combination with a bougie in a Laerdal SimMan manikin with a simulated difficult airway and manual in-line stabilisation.

MAIN OUTCOME MEASURES

The force exerted during laryngoscopy. Success rate and time taken to tracheal intubation were also measured.

RESULTS

Significantly less force was exerted utilising a Macintosh laryngoscope in combination with a bougie compared with the laryngoscope alone (24.9 versus 44.5 N; P < 0.001). The trachea was successfully intubated on all occasions within 120 s. The use of a bougie was associated with a nonsignificant reduction in the time to tracheal intubation.

CONCLUSION

To minimise the force of laryngoscopy and movement of a potentially unstable cervical spine injury, consideration should be given to the early use of a bougie.