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The Gum Elastic Bougie

Created: 24/4/2006
Updated: 6/12/2017
The bougie is an adjunct for difficult endotracheal intubation.


For directional control during routine or difficult endotracheal intubation when the laryngeal inlet cannot be completely seen.


Excessive force, passage beyond the carina, or blind introduction may result in soft tissue damage or may cause rupture of the bronchus.
The endotracheal tube should not be threaded over the introducer without the laryngoscope in place.


1. A 15 French introducer should be used for endotracheal tube sizes 6.0 to 11.0.
2. Lubricate introducer with KY jelly.
3. Perform laryngoscopy. If cords not visible, identify landmarks to aid intubation.
4. Place introducer into the pharynx and direct into larynx. If necessary, bend the introducer to negotiate the corner. Correct placement may be confirmed by detection of tracheal "clicks" and "hold up" of the bougie - no hold up indicates oesophageal placement.
5. Leave laryngoscope in place while assistant threads endotracheal tube over introducer into trachea. If tube sticks at the laryngeal inlet, a 90° counter clockwise rotation may help.
6. Hold the tube firmly in place and gently withdraw the introducer.
7. Remove laryngoscope and confirm tube placement as usual.
8. If preferred, the endotracheal tube may be placed over the introducer prior to intubation, instead of using stylet.

Paediatric considerations

A 10 French introducer should be used for endotracheal tube sizes 4.0 to 5.5.

Tracheal tube intubation stylets

Tracheal Tube Intubation StyletsSingle-use malleable intubation stylets for pre-forming tracheal tubes to the desired shape to facilitate intubation.




[i] Orotracheal intubation in patients with cervical spine injuries. An indication for the gum elastic bougie
Nolan JP, Wilson ME. Anaesthesia 1993; 48: 630-3 (62/1/72)

[ii] An evaluation of the gum elastic bougie, intubation times and incidence of sore throat
Nolan JP, Wilson ME. Anaesthesia 1992; 47: 878-881 (62/1/70)

[iii] The Eschmann Tracheal Tube Introducer (Gum Elastic Bougie). Viswanathan S, Campbell C, Wood DG, Riopelle JM, Naraghi M. Anesthesiol Rev 1992; 19: 29-34 (62/1/71)

[iv] Successful difficult intubation - use of the gum elastic bougie. Kidd JF, Dyson A, Latto IP. Anaesthesia 1988; 43: 437-8 (62/1/27)

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