Gum Elastic Bougie: Tips for Its Use

Today, you are working with a medical student in what would seem to be a straightforward surgical list. The first patient is a 40-yr-old female for a laparoscopic cholecystectomy. On examination, she has a class 2 airway, weighs 80 kg, and is 5′6″. She has no other medical or surgical problems. The medical student places the IV and you induce anesthesia. The patient is easy to mask, and the medical student is doing a good job. You tell the medical student to get the laryngoscope out. He places the scope correctly, but tells you that he can’t see anything. You look and have to agree with him. You decide the patient is a class 3. You take out your gum elastic bougie (GEB), also referred to as an endotracheal tube introducer, and place it blindly in what you think is the trachea. You pass a #7 endotracheal tube (ETT) over the GEB, but have difficultly advancing the ETT. You turn the ETT 90–180 degrees to the right and the ETT glides into what you think is the trachea. As you know, it is impossible to verify correct positioning without removing the GEB from the ETT. The medical student asks you, as you are about to remove the GEB, “Is there any way you could ascertain that you are in the trachea without removing the GEB from the ETT?” You remove the GEB and proceed to verify that the ETT is in the right place. You ponder the question and wonder if there is a way to do it. Is there?