Journal article
Nasotracheal intubation over a bougie vs. non-bougie intubation: a prospective randomised, controlled trial in older children and adults using videolaryngoscopy
Anaesthesia, Vol.72(12), pp.1491-1500
12/2017
DOI: 10.1111/anae.14029
PMID: 28921537
Abstract
Conventionally, nasotracheal intubation has consisted of blind nasal passage and external manipulation of the tube through the glottis ('conventional technique'), a technique associated with a high incidence of nasal trauma. We evaluated a novel technique for routine asleep (i.e. post-induction) nasotracheal intubation using a bougie ('bougie technique'), which uses a nasopharyngeal airway to guide a paediatric bougie nasotracheally for use as a Seldinger tracheal intubation guide. Two hundred and fifty-seven older children (> 8 years) and adults were randomly assigned to videolaryngoscopy-assisted nasotracheal intubation using either the conventional or the bougie technique. The hypothesis was that the bougie technique would result in less nasopharyngeal trauma. The bougie technique was associated with significantly less nasopharyngeal bleeding than the conventional technique at both 60-90 s (55% vs. 68%; p = 0.033) and 5 min (51% vs. 70%; p = 0.002). The severity of bleeding was also significantly less with the bougie technique, with an OR for active bleeding of 0.42 (95%CI 0.20-0.87; p = 0.020) at 60-90 s and 0.15 (95%CI 0.06-0.37; p < 0.0001) at 5 min. Magill forceps were needed significantly less often with the bougie technique (9% vs. 28%, p = 0.0001) and there was no difference in first attempt and overall success rates between the two techniques (p = 0.133 and p = 0.750, respectively). Not only is nasal intubation over a bougie as successful as the conventional technique, it also significantly decreases both the incidence and severity of nasopharyngeal trauma, as well as the need for the use of Magill forceps.
Details
- Title: Subtitle
- Nasotracheal intubation over a bougie vs. non-bougie intubation: a prospective randomised, controlled trial in older children and adults using videolaryngoscopy
- Creators
- R O Abrons - Department of Anesthesiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAM B Zimmerman - Department of Biostatistics, The University of Iowa College of Public Health, Iowa City, Iowa, USAY M S El-Hattab - Department of Anesthesiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Anaesthesia, Vol.72(12), pp.1491-1500
- Publisher
- England
- DOI
- 10.1111/anae.14029
- PMID
- 28921537
- ISSN
- 0003-2409
- eISSN
- 1365-2044
- Language
- English
- Date published
- 12/2017
- Academic Unit
- Biostatistics; Anesthesia
- Record Identifier
- 9983997310502771
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