Bibliographic record
Abstract
We read with interest the report of airway trauma related to the use of gum-elastic bougies during airway management 1. The accompanying editorial succinctly summarises the past, present and possible future of the ‘humble’ bougie 2. In our bariatric anaesthesia practice, we have found wide use for the bougie and often use it electively in super-morbidly obese patients. The bougie is very useful when there is an occlusive proliferation of oropharyngeal soft tissues, as seen in obstructive sleep apnoea and obesity, keeping the time to tracheal intubation as short as possible and avoiding having to implement a rescue ‘Plan B’ 3. We have developed a simple innovation for use of the bougie in bariatric anaesthesia (that may be applicable to other situations), the Preloaded Bougie Technique, in which the bougie is electively preloaded into the tracheal tube and held in place by the pilot balloon (Fig. 1). After induction of anaesthesia and under direct laryngoscopy, the anaesthetist holds the bougie and inserts its curved distal tip through the vocal cords. The assistant then ‘unplugs’ the pilot balloon and holds the proximal tip of the bougie, while the tracheal tube is threaded off into the trachea. The bougie is withdrawn and the tracheal tube connected to the anaesthetic breathing circuit. This technique has several advantages. It improves the speed and efficiency of the bougie manoeuvre because fewer steps are involved, and possibly requires less reliance on the skill of the assistant. From a difficult airway perspective, especially when combined with a McCoy blade, this combination is well known to improve the grade of laryngoscopy and success of intubation 4. At our bariatric centre, it has reduced the need for elective videolaryngoscopy by 50–75% in my personal practice (unpublished observations). Beyond the bariatric population, we have used this technique in patients with limited neck movement (cervical spine injuries), maxillo- facial trauma and in some patients with limited mouth opening, for which bougie techniques have been shown to improve success 5, 6. This technique may also avoid some of the traumatic complications of using the bougie hold-up sign 1. Bougies are widely available globally, economical to use and familiar. Facing extinction at the hands of videolaryngoscopy, I suggest that the use of this technique may help anaesthetists retain direct laryngoscopy skills.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.024 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.007 | 0.010 |
| Insufficient payload (model declined to judge) | 0.004 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".