Airway Management Device Could Serve as an Intubation Alternative

A gum elastic bougie (GEB) device could serve as an alternative anesthetic technique when conventional nasotracheal intubation methods do not work.

Researchers at Kanagawa Dental College (Japan) and Kitasato Institute Hospital (Tokyo, Japan) applied GEB for nasal intubation in 16 patients undergoing dental procedures or oral surgery whose tracheas could not be intubated by conventional techniques. The researchers recommend GEB use rapid and successful tracheal intubation when conventional nasal intubation is difficult due to the tip of the nasotracheal tube not advancing anteriorly into the larynx and trachea through the subglottic region, due to anatomical reasons. It is instead diverted instead posteriorly, into the esophagus or between the vocal cords.

The GEB itself is a 60-cm long tracheal tube introducer that has an external diameter of 5 mm to accommodate tracheal tubes with an internal diameter of over 6 mm. A 35-degree angle tip placed 2.5 cm from the distal end facilitates insertion through the vocal cords when only the epiglottis or the tip of the arytenoids can be visualized. A second operator then threads the tube over the GEB, which may need to be rotated by 90 degrees for the tube to pass. Finally, the GEB is withdrawn, and the correct position of the tracheal tube is confirmed. Capnography may be used to confirm tracheal intubation, along with auscultation of bilateral breathing sounds. The study describing the technique was published in the September 2010 issue of Anesthesia Progress.

"In our experience with use of these methods, this GEB technique is very quick, safe, inexpensive, and easy to perform,” concluded lead author Hirofumi Arisaka, M.D., D.D.S, Ph.D., and colleagues of the department of anesthesiology. "Thus, we recommend the use of GEB from the first attempt for nasal endotracheal intubation in patients with difficult airways.”

Related Links:
Kanagawa Dental College
Kitasato Institute Hospital