Combined Video Laryngoscope and Fiberoptic Nasal Intubation

Articulating Video Stylets in the Setting of Simulated Traumatic Cervical Spine Injury: A Comparison with Four Other Devices and Approaches to Endotracheal Intubation

Background: Simulation offers the opportunity to train healthcare professionals in complex scenarios, such as those with as traumatized patients. Methods: We conducted an observational cross-sectional research simulating trauma with cervical immobilization. We compared five techniques/devices: direct laryngoscopy (DL), videolaryngoscopy (VLS, Glidescope or McGrath), combined laryngo-bronchoscopy intubation (CLBI) and articulating video stylet (ProVu). The primary outcomes were as follows: (1) success rate (SR) by third attempt (each lasting up to 60 s), and (2) corrected time-to-intubation (cTTI, accounting for failed attempts). Results: In a single center, we enrolled 42 consultants experienced in DL/VLS, but reporting no experience with ProVu, and hypothesized that ProVu would have offered encouraging performances. By the third attempt, ProVu had a SR of 73.8%, identical to Glidescope (p = 1.00) and inferior only to McGrath (97.6%; p = 0.003). The cTTI (seconds) of ProVu (57.5 [45-174]) was similar to Glidescope (51.2 [29-159]; p = 0.391), inferior to DL and McGrath (31.0 [22-46]; p = 0.001; and 49.6 [27-88]; p = 0.014, respectively), and superior to CLBI (157.5 [41-180]; p = 0.023). Conclusions: In consultants with no experience, as compared to DL and VLS, the video stylet ProVu showed encouraging results under simulated circumstances of cervical immobilization. The results should be interpreted in light of the participants being novices to ProVu and skilled in DL/VLS. Adequate training is required before the clinical introduction of any airway device.

Combined awake videolaryngo-bronchoscopy intubation with HFNC preoxygenation for predicted difficult airway in a patient with post-burn mentosternal scar contracture

Airway management and safety remain a difficult challenge during reconstructive surgery in patients with extensive post-burn mentosternal scar contractures. Current guidelines do not recommend the use of direct laryngoscopy for predicted difficult airway because of the risk of intubation failure and airway emergencies: the consequences of wrong decisions can be fatal, and the patient is at serious risk. At present, video-laryngoscopy is the most commonly used technique for routine orotracheal intubation. Awake tracheal intubation with fibro-bronchoscopy also remains a valid option when possible, ensuring the patient's spontaneous breathing during the procedure. However, when videolaryngoscopy is used in combination with this method, the efficiency of these devices can be increased, and a better result can be achieved. We report a case of successful management of a predicted difficult airway with combined video laryngo-bronchoscopy in an awake patient with post-burn neck scar contractures.

Airway management in a two-year-old child with a tongue tumor using video laryngoscope-assisted flexible bronchoscopic nasotracheal intubation (hybrid technique)

Airway management in children can be challenging. A hybrid technique using a video laryngoscope-assisted flexible bronchoscopic nasotracheal intubation allowed a successful airway management in a two-year-old child with a large tongue tumor.

Tongue retraction using a McIvor blade improves airway condition during fiberoptic intubation: a randomized controlled trial

Airway clearance is crucial for successful fiberoptic intubation. We hypothesized that tongue retraction using a McIvor blade could facilitate fiberoptic intubation. This randomized clinical trial aimed to compare intubation time and airway condition between the jaw thrust maneuver and tongue retraction with the McIvor blade during fiberoptic intubation. Ninety-four adult patients scheduled for elective surgery were randomly assigned to one of two groups. During fiberoptic intubation, airway clearance was secured by applying the jaw-thrust maneuver (J group) or by tongue retraction using the McIvor blade (M group). We assessed the total intubation time, number of attempts for tube advancement, and airway clearance at the soft palate and epiglottis levels. The total intubation time was significantly shorter in the M group than in the J group (p = 0.035). The number of attempts to advance the tube was significantly lower in the M group (p = 0.033). Airway clearance at the soft palate level was significantly better in the M group than in the J group (p = 0.027). Retracting the tongue with the McIvor blade demonstrated a better condition for fiberoptic intubation and shortened total intubation time compared with the jaw-thrust maneuver.Clinicalregistiration: CRIS; http://cris.nih.go.kr (KCT0002392) registered 28/07/2017.

Video-Twin Technique for Airway Management, Combining Video-Intubating Stylet with Videolaryngoscope: A Case Series Report and Review of the Literature

Direct laryngoscopy (DL) and videolaryngoscopy (VL) have been the most commonly used airway management modalities in the last several decades. Meanwhile, various optional airway tools (e.g., supraglottic devices, fiberoptic bronchoscopes) have been used for alternative rescue modalities when anticipated or unexpected difficulties in airway management has occurred. In recent decades, optical stylets and video-assisted intubating stylets have become another option for difficult airway scenarios. In contrast to other approaches, we have adopted the Shikani video-assisted intubating stylet technique (VS) for both routine and difficult airway management scenarios. In this case series report, we present the video-twin technique, combining a videolaryngoscope with a video-assisted intubating stylet in various clinical case scenarios. We propose that such a combination is easy to learn and employ and is particularly beneficial in situations where an expected difficult airway (EDA) is encountered.