Case 33: At Times You Need to Be a MacGyver

  • John G. Brock-Utne


You find yourself in a foreign land on a medical mission with plastic surgeons repairing facial deformities. As the only anesthesiologist, you are in charge of the anesthesia equipment. You are requested to anesthetize a large man (180 kg) for removal of scars from his face. His neck is over 40 cm in diameter. Unfortunately, your box with airway equipment like a fiber-optic scope, gum elastic bougies, etc. has not yet arrived. Through a translator (you don’t speak his language) you tell him them you would like to attempt an awake intubation under local anesthesia. The patient is terrified and wants to be asleep. You realize that you may need to have a gum elastic bougie as a backup. You start looking for possible ways of making a bougie from what you have available. The 18 Fr nasogastric tube would be too soft and the suction catheters you have are too short.


Difficult airway Rural anesthesia Neck circumference Facial deformities General anesthesia Nasogastric tube Paper clip Oxygen insufflation 


  1. 1.
    Manos SJ, Jaffe RA, Brock-Utne JG. An alternative to the gum elastic bougie and/or the jet stylet. Anesth Analg. 1994;79:1017.CrossRefPubMedGoogle Scholar
  2. 2.
    Manos SJ, Jaffe RA, Brock-Utne JG. Airways, paper clips and nasogastric tubes. Anesth Analg. 1995;81:208–9.Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • John G. Brock-Utne
    • 1
  1. 1.Department of AnesthesiaStanford UniversityStanfordUSA

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