Application of the self-inflating bulb to a hollow intubating introducer

The aspiration test, performed by a self-inflating bulb (SIB), is a simple and reliable method to detect an accidental esophageal intubation. The aim of the study, in case of employment of a hollow intubating introducer (HII), was to verify the possibility to directly perform the test with the introducer and its efficacy in allowing the detection of its position.

prospective, randomized study.

operating theater in a university hospital.

adult patients, without evidence of gastro-esophageal or tracheobronchial pathologies, scheduled for elective surgery.

patients were randomized in two groups T (HII was placed in trachea) and E (HII was positioned in the esophagus). Under general anesthesia, a HII was placed in either the trachea or the esophagus. A blinded anesthesiologist connected the SIB to the HII and performed the test twice.

the anesthesiologist inferred the position of the device, based on the re-inflation observed.

One hundred subjects were studied. In group E patients, a prompt and complete re-inflation of the bulb was never observed and the anesthesiologist correctly inferred the position of the HII. Occasionally (3.5% of cases), in group T patients, a prevented or incomplete re-inflation of the bulb occurred, leading to an incorrect judgment of the HII position.

The aspiration test with the SIB allows the proper detection of the introducer in esophagus. When used in combination with a HII, both time and local trauma associated with an erroneous, introducer-guided esophageal intubation in case of difficult laryngoscopy may be reduced.