International Journal of Anesthesiology & Pain Medicine

Intubation Times with the Bougie versus Stylet in the Immobilized Cervical Spine: A Randomized Trial

Purpose: Endotracheal Intubation (ETI) in patients with an immobilized cervical spine is often challenging, urging the use of airway adjuncts like bougie and stylet and a Video Laryngoscope (VL). Owing to the scarcity of comparative literature, we aimed to compare the intubation characteristics when using either a bougie or a stylet with a VL in these patients.

Methods: This randomized controlled study involved eighty six adult ASA I/II patients with cervical spine immobilized with a collar or traction, scheduled for cervical spine surgery, between July 2020 and December 2021. ETI was performed with the C-MAC VL, assisted with bougie (group ETB) or stylet (group ETS). The primary outcome was time to successful ETI. First Attempt Success (FAS) rate, overall successful ETI, cervical spine motion detected using fluoroscopy and complications were secondary outcomes.

Results: The time for ETI in group ETB was 52.38± 6.23 sec (n=43), and in group ETS was 52.39 ± 32.85 sec (n=43), P=0.958. There was no significant difference in FAS rate, overall success of intubation or cervical spine movement between the groups. No complications were encountered.

Conclusions: In patients with an immobilized cervical spine, there was no significant difference in the intubation times when comparing the bougie and the stylet. The FAS rate was also similar in both groups with minimal motion at C1, C2. Both bougie and stylet are equally useful adjuncts when used with a VL, while intubating patients in whom neck movements are restricted.

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