Esophageal dilatation
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
Interventions for children with esophageal strictures have been performed since the Middle Ages. Fabricius ab Aquapendente first described instrumentation of the esophagus with tapered lengths of wax in the 16th century. The term “bougienage” derives from the French word for a wax candle, a bougie. Other pioneers such as Ambrose Pare (1510–1590), Wilhem Fabry (1560–1634) and Thomas Willis (1621–1675) carried out disimpaction and dilatation of the esophagus with readily available natural materials including leather tubes, osiers made from willow, whale bone, and swan quills. A number of descriptive phrases were used early on including esophageal “sounds,” a term still used in modern medicine. This was thought to originate from the noise of esophageal dilators hitting impacted, metal foreign bodies. These original dilators were the precursors of a range of manufactured and more effective ones such as the gum elastic bougies developed by the American laryngologist Chevalier Jackson (1865–1958).
Military Environments
Kenneth D Boffard in Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Prior to RSI, equipment and team preparation is paramount. A trained anaesthetic assistant should be available and ideally a second clinician whose role is to administer drugs and to monitor vital signs. A team member should be designated to perform thoracostomy should a tension pneumothorax become evident. In the event of cervical spine control being necessary, any cervical collar should be opened or removed and replaced with manual in-line stabilization by another team member. All equipment should be checked daily and again prior to casualty arrival. Minimum equipment immediately available includes: Self-inflating bag and correctly sized facemask.Two sizes of laryngoscope (MAC 3 and 4 for adults).Appropriately sized endotracheal tubes.Failed/difficult intubation equipment.Bougie.Oropharyngeal and nasopharyngeal airways.Laryngeal mask airway (ideally second generation e.g. ProSeal®, iGel®).Alternative laryngoscope (e.g. AirTraq®, Glidescope® if available).Surgical airway equipment.Working suction.Monitoring including end-tidal CO2, ECG, non-invasive blood pressure (NIBP) and SpO2.
Predictors of Definitive Airway Sans Hypoxia/Hypotension on First Attempt (DASH-1A) Success in Traumatically Injured Patients Undergoing Prehospital Intubation
Published in Prehospital Emergency Care, 2020
Elizabeth K. Powell, William R. Hinckley, Uwe Stolz, Andrew J. Golden, Amanda Ventura, Jason T. McMullan
Lack of airway secretions/blood and Cormack-Lehand Score of 1 or II were both associated with improved first pass and DASH-1A success. This is somewhat intuitive as improved visualization of the vocal cords likely leads to more rapid intubation and less potential for hypoxia. This emphasizes the importance of suction and optimized positioning and visualization techniques prior to any airway attempts. In the multivariable analyses, use of a bougie was associated with increased overall intubation and DASH-1A success. Though not evident from univariate comparisons, bougie use was significantly associated with both outcomes when controlling for multiple other variables. We suspect that providers used the bougie when they predicted a challenging airway, such as those contaminated by secretions/blood, which may be why the associations were significant only after controlling for other variables. The bougie could be considered and readily available in all patients, whether or not a difficult airway is suspected. A recent study conducted in the emergency department showed a similar association with increased first-pass intubation success when using a bougie (13). As the use of the bougie itself requires training and familiarity we recommend incorporation of the bougie into airway training.
Laparoscopic sleeve gastrectomy for morbid obesity in a Belgian-French prospective multicenter study: outcomes and predictors weight loss failure
Published in Acta Chirurgica Belgica, 2021
Imad El Moussaoui, Etienne Van Vyve, Hubert Johanet, André Dabrowski, Arnaud Piquard, Thierry Delaunay, Benoît Navez, Philippe Hauters, Frank Sirisier, Patrizia Loi, Jean Closset
We did not find any relationship between some technical surgical points and the weight loss results. Application of a thinner bougie ( < 35 F) during the calibration of the stomach tube and closed distance of the staple line to the pylorus ( < 6 cm) were not significantly correlated with weight loss success. In the literature there is still no consensus on the size of bougie. Yuval et al. reviewed 32 publications consisting of 4999 patients, they found that in groups where a larger bougie (≥40 F) was used, the rate of leak was lower, but there was no difference in weight loss [33]. The high leak rates observed when using narrow bougie could be attributed to increased intragastric pressure, wall tension and ischemia in the staple line [14,33]. Another controversial point is the stapling distance from the pylorus, in the most recent randomized study [34], authors found an accelerated gastric emptying and higher antral volume in the antral preservation group (antrum resection 5 cm from the pylorus) compared to antrum resection group (antrum resection 2 cm from the pylorus), the two groups were similar in terms of %EWL at 1 year. In another recent prospective randomized study, no difference was found in terms of %EWL at 1 year, quality of life and improvements in comorbidities between 2 vs. 6 cm distances from the pylorus, however, weight loss was greater in the 2 cm group at 6 months [35].
Novel Technologies and Techniques for Prehospital Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Catherine R. Counts, Justin L. Benoit, Graham McClelland, James DuCanto, Lauren Weekes, Andrew Latimer, Mohamed Hagahmed, Francis X. Guyette
Bougies, or tracheal tube introducers, have been in use as a difficult airway adjunct device for over 65 years. They were introduced into North American practice more recently than in Europe and Australia, gaining in popularity since the early 2000s (8). Compared to the hospital setting, prehospital advanced airway management is known to have more complications due to factors such as airway anatomy and altered physiology, environmental issues, and training/experience of the operator. Therefore, it is reasonable to believe that a bougie may offer additional benefits in the prehospital setting to mitigate the risks of repeated attempts at intubation (9,10).
Related Knowledge Centers
- Endoscopy
- Esophageal Cancer
- Scleroderma
- Esophagus
- Lumen
- Esophageal Stricture
- Eosinophilic Esophagitis
- Schatzki Ring
- Esophageal Achalasia
- Physician