I have read the comments by Xue et al and I agree that the
gum elastic bougie should not be inserted too deeply or too shallowly.
Gum elastic bougie-guided placement of the ProSeal laryngeal mask.
Where a
gum elastic bougie is used, failure to rotate the endotracheal tube 90[degrees] anti-clockwise before approaching the larynx may cause impingement and trauma to the arytenoid.
Group G (n=32): the PLMA (The Laryngeal Mask Company, UK) was inserted using a Gum Elastic Bougie with rounded ends (Portex Tracheal Tube Introducer, Portex Ltd, UK) (Figure 1).
Gum Elastic Bougie guided insertion of Proseal[TM] laryngeal mask airway is superior to digital and introducer tool techniques.
Pharyngeal wall perforation: An unusual complication of blind intubation with a gum elastic bougie.
The use of a
gum elastic bougie in combination with a videolaryngoscope.
The technique involved (1) the patient adopting the prone position with the head to the side and the table tilted laterally, (2) pre-oxygenation to end-tidal oxygen >90%, (3) induction of anaesthesia with midazolam/alfentanil/propofol, (4) facemask ventilation (5) a single attempt at digital insertion and if unsuccessful a single attempt at laryngoscope-guided, gum elastic bougie-guided insertion, (6) gastric tube insertion, (7) maintenance of anaesthesia with sevoflurane/[O.sub.2]/[N.sub.2]/O, (8) volume controlled ventilation at 8-12 ml/kg,, (9) emergence from anaesthesia in the supine position, and (10) removal of the ProSeal LMA when awake Facemask ventilation was always successful.
If digital insertion failed, the second attempt was with the laryngoscope-guided, gum elastic bougie-guided technique".
However, another method of insertion has recently been described by Brimacombe (2), which involves passing a
gum elastic bougie though the drain tube (Figure 1), passing the tip of the bougie into the oesophagus using a laryngoscope (optional) and then sliding the ProSeal into the lower pharynx using the bougie as a guide.