• Nobuyasu Komasawa, Akira Hyoda, Sayuri Matsunami, Nozomi Majima, and Toshiaki Minami.
• Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
• Biomed Res Int. 2015 Jan 1; 2015: 617805.

BackgroundDirect laryngoscopy with the Miller laryngoscope (Mil) for infant tracheal intubation is often difficult to use even for skilled professionals. We performed a simulation trial evaluating the utility of a tracheal tube introducer (gum-elastic bougie (GEB)) in a simulated, difficult infant airway model.MethodsFifteen anesthesiologists performed tracheal intubation on an infant manikin at three different degrees of difficulty (normal [Cormack-Lehane grades (Cormack) 1-2], cervical stabilization [Cormack 2-3], and anteflexion [Cormack 3-4]) with or without a GEB, intubation success rate, and intubation time.ResultsIn the normal and cervical stabilization trials, all intubation attempts were successful regardless of whether or not the GEB was used. In contrast, only one participant succeeded in tracheal intubation without the GEB in the anteflexion trial; the success rate significantly improved with the GEB (P = 0.005). Intubation time did not significantly change under the normal trial with or without the GEB (without, 12.7 ± 3.8 seconds; with, 13.4 ± 3.6 seconds) but was significantly shorter in the cervical stabilization and anteflexion trials with the GEB.ConclusionGEB use shortened the intubation time and improved the success rate of difficult infant tracheal intubation by anesthesiologists in simulations.

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