A comparison of simulated difficult intubation with multiple-use and single-use bougies in a manikin

In a randomised cross-over study, 20 anaesthetists attempted to place a multiple- or single-use bougie in the trachea of a manikin, in which a grade 3 Cormack and Lehane laryngoscopic view was simulated. The anaesthetists made two attempts at placement with each bougie and were blinded to success (tracheal placement) or failure (oesophageal placement). The success rates for the first attempts with the multiple- and single-use bougies were 85 and 15%, respectively [mean (95% CI) difference between the two bougies 70% (40-84%); p < 0.001]. The success rates for the second attempts were similar to those for the first attempts with both bougies. There is an increased risk of failure to intubate the trachea when using a single-use bougie, and this must be weighed against the unquantified risk of cross-infection from prions when using a multiple-use bougie.