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The Eschmann Tracheal Tube Introducer Is Not Gum, Elastic, or a Bougie

El-Orbany, Mohammad I. M.D*; Salem, M Ramez M.D; Joseph, Ninos J. B.S

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To the Editor:—

We read with interest the article by Brimacombe et al.1 in which the authors demonstrated the superiority of the Eschmann introducer–guided technique of ProSeal™ LMA (The Laryngeal Mask Company, Ltd., San Diego, CA) insertion over digital and introducer tool techniques. The authors are to be commended for their study, but we are concerned that the Eschmann endotracheal tube introducer was referred to as a gum elastic bougie. The gum elastic bougie is a urinary catheter that was originally used for dilation of urethral strictures. This catheter was used as an endotracheal tube introducer (to facilitate difficult tracheal intubation) by Sir Robert R. Macintosh2 in 1949. Inspired by Macintosh’s report, Venn3 designed the currently used introducer in the early 1970s. He was then the anesthetic advisor to the British firm Eschmann Bros. & Walsh, Ltd. of Shoreham-by-Sea, West Sussex, United Kingdom, which accepted the design in March 1973.3 The material of the newly designed introducer was different from that of a gum elastic bougie in that it had two layers: a core of tube woven from polyester threads and an outer resin layer. This provided more stiffness but maintained the flexibility and the slippery surface. Other differences were the length (the new introducer was 60 cm, which is much longer than the gum elastic bougie, thus facilitating endotracheal tube railroading over it) and the presence of a 35° curved tip, permitting it to be steered around obstacles.4,5 The Eschmann endotracheal tube introducer went into production shortly after design acceptance in 1973, and all three design differences (material, length, and curved tip) have contributed throughout the years to the reported success with its use and widespread popularity.6 As has been previously pointed out by Viswanathan et al.4 in a review article, the Eschmann endotracheal tube introducer is not made of gum, is not elastic, and is not used as a bougie. Because of these differences between the two devices in design and function, we strongly recommend that the Eschmann endotracheal tube introducer should no longer be referred to as a gum elastic bougie.
Mohammad I. El-Orbany M.D.,*
M. Ramez Salem M.D.
Ninos J. Joseph B.S.
* Advocate Illinois Masonic Medical Center, Chicago, Illinois. mohammad.el-orbany-md@advocatehealth.com
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References

1. Brimacombe J, Keller C, Judd DV: Gum elastic bougie–guided insertion of the ProSeal™ laryngeal mask airway is superior to the digital and introducer tool techniques. Anesthesiology 2004; 100:25–9

2. Macintosh RR: An aid to oral intubation (letter). BMJ 1949; 1:28

3. Venn PH: The gum elastic bougie. Anaesthesia 1993; 48:274–5

4. Viswanathan S, Campbell C, Wood DG, Riopelle JM, Naraghi M: The Eschmann tracheal tube introducer (gum elastic bougie). Anesthesiol Rev 1992; 19:29–34

5. Henderson JJ: Development of the “gum-elastic bougie.” Anaesthesia 2003; 58:103–4

6. Kidd JF, Dyson A, Latto IP: Successful difficult intubation: Use of gum elastic bougie. Anaesthesia 1988; 43:437–8

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