Great to see this published in @Anaes_Journal TLDR - Stylets best for hyperangulated VL intubation Dynamic bougies next best Standard bougies worst Effects more marked when difficulty increases Manikin studies are often criticised, but may in some cases be the optimal design. There is a weakness of most clinical studies: even in 'high risk' or 'predicted difficult' cohorts most (>80%) intubations are simple so don't stress test the technique. This creates a false reassurance in results. We used a specific difficult intubation manikin from @LimbsandThings1 It enabled us to set up a reproducible - straight forward HAVL intubation - genuinely difficult one (tricky 2b view) So we really did stress the technique.... We studied -Storz C-MAC Stylet (@KARLSTORZUK) -Universal Stylet Bougie (@intersurgical) -Total Control Introducer (@RunnelsSean) -Steerable Tracheal Intubation Guide (@LateralMedical) -Portex Single-Use Bougie 30 participants (familiar with D-blade use) intubated the manikin with each adjunct (after familiarisation, random order) in the easy and difficult set-up (again randomised) Clear separation of performance -Stylets best (excellent) -Dynamic bougies next best (still good) -Standard bougie worst (poor) When the chips are down the separation of performance was increased -stylet FPS close to 100% -bougie performance close to 35% Success rate, time, effort, VRS scores all support these findings. Don't get fooled into thinking bougies work well with HAVL by studies that don't stress test the technique. Don't get stuck with the wrong tool! Well done to all the staff at @RUHAnaesthesia who did the study or participated & @VirtueOfNothing associationofanaesthetists-p…