The gum elastic bougie eases tracheal intubation while applying cricoid pressure compared to a stylet

  • Takashi Noguchi
  • Kazunori Koga
  • Yousuke Shiga
  • Akio Shigematsu
Cardiothoracic Anesthesia, Respiration and Airway



To compare the ease of tracheal intubation facilitated by the gum elastic bougie or the malleable stylet while applying cricoid pressure.


Sixty American Society of Anesthesiologists I–III adult patients undergoing elective surgeries participated in this study. After induction of anesthesia with 2.5 mg·kg−1 propofol and vecuronium 0.1 mg·kg−1, the laryngeal view was assessed without and with cricoid pressure. Patients were allocated randomly into two groups: a gum elastic bougie or stylet group. One of the two devices was used for tracheal intubation while applying cricoid pressure. The duration and ease of tracheal intubation was recorded.

Main results

In 58 patients, the trachea was intubated at the first attempt. In the stylet group, tracheal intubation was difficult and needed more time, especially when the glottic opening was not visible. In the bougie group, the duration and ease of intubation was not influenced by laryngeal view. In the remaining two patients with Cook’s modified 3b laryngeal view, it was impossible to intubate the trachea with these devices.


Applying cricoid pressure worsened laryngeal view. The use of a gum elastic bougie was more effective than the use of a stylet to facilitate intubation.


Tracheal Intubation Tracheal Tube Cricoid Pressure Rapid Sequence Induction Difficult Tracheal Intubation 
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La bougie flexible, comparée au stylet, facilite l’intubation endotrachéale pendant la compression cricoïdienne



Comparer l’intubation endotrachéale facilitée par la bougie flexible ou le stylet maniable pendant l’application de la compression cricoïdienne.


Soixante patients adultes, d’état physique ASA I– III, devant subir une intervention chirurgicale réglée ont participé à l’étude. Après l’induction de l’anesthésie avec 2,5 mg·kg−1 de propofol et 0,1 mg·kg−1 de vécuronium, la visualisation du larynx a été évaluée avec et sans compression cricoïdienne. Les patients ont été répartis au hasard en deux groupes pour l’intubation endotrachéale avec la bougie flexible ou le stylet pendant l’application de la compression cricoïdienne. La durée et la facilité de l’intubation ont été notées.

Constatations principales

Chez 58 patients, l’intubation a été réussie au premier essai. Dans le groupe avec stylet, l’intubation a été difficile et a exigé plus de temps, surtout quand l’ouverture glottique n’était pas visible. Dans le groupe avec bougie, la duré et la facilité de l’intubation n’ont pas été influencées par la visualisation du larynx. Chez les deux patients restants qui présentaient une vue laryngée de classe 3b modifiée de Cook, il a été impossible de réaliser l’intubation avec l’un ou l’autre instrument.


L’application de la compression cricoïdienne a nui à la visualisation du larynx. La bougie flexible a été plus efficace que le stylet pour faciliter l’intubation.


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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Takashi Noguchi
    • 1
  • Kazunori Koga
    • 2
  • Yousuke Shiga
    • 1
  • Akio Shigematsu
    • 2
  1. 1.Department of AnesthesiaChikuho Rosai HospitalKaho-gun
  2. 2.Department of AnesthesiaUniversity of Occupational and Environmental Health, School of MedicineKitakyushuJapan

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