The effect of sterilisation on the plasticity of multi-use Eschmann gum elastic bougies: a bench and manikin study.

We investigated the deterioration in plasticity of the multi-use Portex Tracheal Guide ('bougie') with repeated sterilisation. Six bougies were prepared by washing them between 0 and 100 times (in accordance with the manufacturer's guidelines). Two tests were employed: a bench test in which rapid serial photographs were taken of the bougies uncoiling from a preformed curve; and a manikin-based test in which the six bougies were used in a simulated difficult airway. The bench test demonstrated a progressive deterioration in plasticity with repeated washing. However, the manikin-based test showed no significant difference between bougies in the incidence of oesophageal placement (p = 0.74). Time to placement differed significantly only between the two most-washed bougies but was broadly similar. We suggest therefore that the manufacturer's limit of five washings may be unnecessarily cautious.