A case of Nasal Bougie Intubation (Dr. Talwalkar's bougie) in an extremely difficult, almost impossible intubation situation in an Ankylosing Spondylitis + Extremely Obese patient. A 51-year-old Ankylosing Spondylitis patient was posted for Thoracic Spine Fracture Fixation surgery . Fibreoptic and video laryngoscopy were not readily available. The patient’s hypognathic fixed head totally hampered intubation efforts. During nasal intubations, the ET tube often directs itself directly into the trachea, even without Magill’s forceps.
This thought came into my mind, by God’s infinite grace. Immediately I took Talwalkar’s bougie and inserted it gently through the left nostril. I could feel the tracheal rings and carina below at Lewis angle level on sternum from outside. I then inserted the ET tube and completed the surgery in prone position for 5 hours. The patient recovered well and was…
