Efficacy of bougie in difficult intubation with the Airway Scope caused by inability to lift the epiglottis directly

BACKGROUND: There are some disadvantages of the Airway Scope (AWS), and the most crucial one is that the AWS has only one fixed-size AWS blade. When the blade is too short to reach beneath the epiglottis and to lift it directly, an endotracheal tube hits the epiglottis and cannot be advanced into the glottic aperture even when it is visible. A bougie may solve this difficulty because its angulated tip can be controlled in a desired direction. Therefore, we examined the efficacy of the bougie on this problem. METHODS: Forty patients were randomly classified into two groups: intubation with only the AWS, and with the AWS and the bougie. After general anesthesia and muscle relaxation, the AWS blade tip was positioned in the vallecula, the glottis was fully exposed, and intubation using the AWS with or without a bougie was performed. Success rate and time to intubation were compared in both groups. RESULTS: Success rate was 13/20 in intubation with only the AWS and 19/20 in intubation with the AWS and the bougie (P<0.05). Median intubation time was reduced from 48 sec without the bougie to 29 sec with the bougie (P<0.01). CONCLUSIONS: Use of the bougie was useful for difficult intubation with the AWS caused by inability to lift the epiglottis directly.