Comparison of a New Video Intubation Stylet and McGrath® MAC Video Laryngoscope for Intubation in an Airway Manikin with Normal Airway and Cervical Spine Immobilization Scenarios by Novice Personnel: A Randomized Crossover Study

Structured Routine Use of Styletubation for Oro-Tracheal Intubation in Obese Patients Undergoing Bariatric Surgeries-A Case Series Report

The aim of this case series report is to provide a new topical view of styletubation (video intubating stylet technique) in obese patients undergoing bariatric surgeries. In contrast to various conventional direct laryngoscopes (DLs), videolaryngoscopes (VLs) have been applied in such obese populations with potentially difficult airway complications. The safety and effectiveness of VLs have been repeatedly studied, and the superiority of VLs has then been observed in and advocated for routine use. In this article, among our vast use experiences with styletubation (more than 54,998 patients since 2016) for first-line routine tracheal intubation, we present the unique experience to apply the styletubation technique in obese patients undergoing bariatric surgery. Consistent with the experiences applied in other patient populations, we found the styletubation technique itself to be swift (the time to intubate from 5 s to 24 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satisfaction). The learning curve is steep, but competency can be enhanced if technical pitfalls can be avoided. We, therefore, propose that the styletubation technique can be feasibly and routinely applied as a first-line airway modality in obese patients undergoing bariatric surgery.

An Approach to Improve the Effectiveness of the Video-Assisted Intubating Stylet Technique for Tracheal Intubation: A Case Series Report

Direct laryngoscopy and videolaryngoscopy are currently the dominant tools for endotracheal intubation. However, the video-assisted intubating stylet, a type of videolaryngoscopy, has been shown to offer some advantages over these tools, such as rapid intubation time, high first-attempt success rates, less airway stimulation, and high subjective satisfaction. On the other hand, this optical intubating technique also has some technical limitations that need to be addressed, including camera lens fogging, airway path disorientation, and obscured visibility due to secretions. In this clinical report, we describe an approach that improves the visibility of the glottis by introducing a suctioning catheter into the nasopharyngeal airway to enhance the efficiency and accuracy of using the intubating stylet technique for tracheal intubation.

A manikin study comparing the performance of traditional Macintosh laryngoscope, GlideScope®, Airtraq®, and video-optical intubation stylet in endotracheal intubation used by emergency doctors in simulated difficult airway intubation: A pilot study

Background:

The video-optical intubation stylet (VS) is a slim, rigid but flexible intubating device that aids physicians to intubate patients, particularly with difficult airways.

Objectives:

The objective of this study was to compare the performance of emergency department doctors in using different intubating devices for intubation in an airway manikin simulating different difficult airway scenarios.

Methods:

Thirty emergency department doctors were recruited in a pilot study. Their performance of using traditional Macintosh laryngoscope, GlideScope®, Airtraq® and C-MAC® Video Stylet were compared in three situations: normal, restricted cervical motion and limited oral aperture. The time for intubation, first attempt success rate, failure rate, dental injury and the subjective ease of different devices by the participants were compared.

Result:

The mean intubation time by VS in each scenario was significantly shorter compared with other devices (Normal: 19.77s vs 24.67–28.19s, p = 0.014; Cervical restriction: 20.85 vs 26.17–31.26s, p = 0.008; Limited oral aperture:19.03 vs 29.35, p = 0.001). However, there was no significant difference in failure rate or first attempt success rate. The incidence of dental injury was significantly lower with VS than other laryngoscopes (p = 0.001, p < 0.05 and p < 0.05 in normal, cervical restriction and limited oral aperture scenarios, respectively). Moreover, participants appreciated that VS was the easiest device to intubate in each scenario. (p < 0.05 in all scenarios)

Conclusion:

The performance of VS was comparable to or even better than the commonly used laryngoscopes in the emergency department in airway management. When adequate training is provided, VS can be a potentially good alternative for tracheal intubation in different situations.

The Use of the Shikani Video-Assisted Intubating Stylet Technique in Patients with Restricted Neck Mobility

Among all the proposed predictors of difficult intubation defined by the intubation difficulty scale, head and neck movement (motility) stands out and plays as a crucial factor in determining the success rate and the degree of ease on endotracheal intubation. Aside from other airway tools (e.g., supraglottic airway devices), optical devices have been developed and applied for more than two decades and have shown their superiority to conventional direct laryngoscopes in many clinical scenarios and settings. Although awake/asleep flexible fiberoptic bronchoscopy is still the gold standard in patients with unstable cervical spines immobilized with a rigid cervical collar or a halo neck brace, videolaryngoscopy has been repeatedly demonstrated to be advantageous. In this brief report, for the first time, we present our clinical experience on the routine use of the Shikani video-assisted intubating stylet technique in patients with traumatic cervical spine injuries immobilized with a cervical stabilizer and in a patient with a stereotactic headframe for neurosurgery. Some trouble-shooting strategies for this technique are discussed. This paper demonstrates that the video-assisted intubating stylet technique is an acceptable alternative airway management method in patients with restricted or confined neck motility.