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Epidural anaesthesia and analgesia for liver resection

therefore potentially better tolerated), cheaper and readily available. Also, anaesthetists are familiar with standard bougies and feel comfortable with their use. In our audit of 18 patients, a standard bougie (Frova Intubating Introducer, Cook Medical, Bloomington, USA) was inserted immediately before extubation. In order to minimise the risk of trauma associated with endobronchial placement, the centimetre markings on the bougie were used to ensure that insertion was no more than 1–2 cm further than the tip of the tracheal tube. The bougie was then secured to the face of the patient. Ease of extubation over the bougie and patients’ tolerance of the bougie were evaluated by the anaesthetist (scored out of 10). Extubation over the bougie was considered easy in the majority of cases (median score 10/10 [IQR 9–10]) and the use of a bougie was very well tolerated by patients during emergence (median score 10/10 [IQR 7–10]). The bougies remained in situ for a median (IQR) time of 9 (5–12) min and one patient tolerated a bougie overnight in level-2 care. In 14 of 18 patients, the bougie was easily removed once the airway was deemed to be secure. The bougie was not tolerated in two patients and became dislodged in the remaining two patients. In the one case that needed re-intubation, this was successfully and easily performed over the bougie. Although further studies are needed, our findings suggest that the use of a bougie to maintain airway access in patients waking from head and neck surgery is feasible and surprisingly well tolerated. We believe that this simple manoeuvre should be considered more often in routine anaesthetic practice.