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We think the lung trauma described by Prabhu et al. (Anaesthesia 2003: 58: 811–3) was caused by a straight tip Eschmann gum elastic bougie and not by a coude tip (bent tip) one because:

  • 1
    A straight tip will not sense tracheal rings; none were felt.
  • 2
    Hold up occurred very deep at 50 cm; normal depth for a female using coude tip would be 30–35 cm.
  • 3
    Knowledge of the two types of bougie is not universal [1].
  • 4
    Kettering hospital has both coude and non-coude tip introducers.

If you push a coude tip into a plungerless 2 ml syringe (which mimics a bronchus), you can easily see why the coude tip does not plug and split a bronchus.

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