Evaluation of Flexible Tip bougie in simulated difficult intubation: a randomized cross-over manikin study


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Kuan, T. Y., & Mohamed, A. H. (2023). Evaluation of Flexible Tip bougie in simulated difficult intubation: a randomized cross-over manikin study. Malaysian Journal of Anaesthesiology, 2(1), 56–68. https://doi.org/10.35119/myja.v2i1.40

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Copyright (c) 2023 Tong Yin Kuan, Abdul Hadi Mohamed


airway management; intubation; laryngoscope; manikin


Introduction: Both video laryngoscopes and bougies play major role in difficult airway management. Even when a video laryngoscope is available to improve intubation view, there are instances when the vocal cords are visible, but intubation cannot be achieved. In these cases, bougies have a role in assisting intubation. This study aimed to compare the efficacy of the Flexible Tip Bougie with others in simulated difficult intubation.

Methods: This study was designed as a randomized, cross-over, simulation manikin study. It involved 42 medical officers from the Department of Anaesthesiology. In the study, participants performed intubation under simulated difficult airway conditions. Three types of bougie were used by each participant in random order: (1) Flexible Tip Bougie, (2) Portex Single-Use Introducer, and (3) Frova Intubating Introducer.

Results: The intubation success rate was 100% for the Flexible Tip Bougie, 78.6% for the Frova Intubating Introducer, and only 50% for the Portex Single-Use Introducer (p < 0.001). The median intubation time was shortest with the Flexible Tip Bougie, at 16.08 s (interquartile range [IQR]: 6.13); 18.25 s (IQR: 18.07) with Frova, and 19.39 s (IQR: 37.60) with Portex (p = 0.449). The ease of use was lowest with Portex (69.64, standard deviation [SD]: 32.45), average with Frova (50.59, SD: 29.98), and highest with Flexible Tip (16.67, SD: 21.86; [p < 0.001]).

Conclusion: In this manikin study, the Flexible Tip Bougie was more efficient in achieving successful intubation and easier to use than the Portex and Frova introducers in a difficult intubation scenario.



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