How to Apply to Nasal Intubation by Gum Elastic Bougie

Objectives: Gum elastic bougie (GEB), a useful device for difficult airway management. Therefore, the use of GEB is well documented for difficult oral intubations but GEB is seldom applied for nasal intubation. When direct laryngoscopy intubation is not usually possible because of limited mouth opening, fiberoptic intubation represents an effective approach to intubation.However, fiberoptic intubation is often time consuming. We report the clinical application of GEB for difficult nasal intubation. Methods: GEB is used for patients in whom conventional nasal intubation had failed due to anatomical problems or mal-direction of the tip of tracheal tube. Direct laryngoscopy is performed in the usual fashion. The nasal tube is pulled back until only the tip of the tube is visualized in the pharynx. Spraying 8% lidocaine into the tube facilitates smooth insertion of a GEB. The tip of the GEB is pointed towards the area where the glottis is likely to exist. The GEB is advanced through the vocal cords, using Magill forceps if required. After the correct position of a GEB has been confirmed, the tracheal tube is gently threaded down into the trachea over the GEB. Finally, the GEB is withdrawn and the position of the tracheal tube is confirmed. Capnograph may be used to confirm tracheal intubation. Results: Among 632 patients undergoing dental procedures or oral surgery, GEB was successfully used in 16 patients in whom conventional nasal intubation had failed because of anatomical problems or mal-direction of the tip of tracheal tube. Conclusion: In this study using these methods, this GEB technique is very quick, safe, inexpensive and easy to be performed. Thus, GEB is suggested to be useful for nasal intubation in patients with difficult airways.