A Paradigm Shift of Airway Management: The Role of Video-Assisted Intubating Stylet Technique

Abstract

Difficult or failed intubation is a major contributor to morbidity for patients and to liability for the provider. Research to improve understanding, prevention, and management of such complications remains an anesthetic priority, and a driving force behind continuous improvements in intubation techniques and intubation equipment. The purpose of this review article is to focus on the video-assisted intubating stylet technique (VS; also known as the Shikani optical stylet technique for intubation) and video-assisted optical stylet devices, both for routine use and alternative rescue application for tracheal intubation, and stress their advantages as compared to conventional direct laryngoscopy and videolaryngoscopy. The VS technique was introduced by Dr. Alan Shikani in 1996 and popularized with the advent of the Shikani optical stylet and subsequent similar stylets variations. We focus on the clinical details of the technique itself, and on the various advantages and troubleshooting under different clinical scenarios and practice settings. In our experience, video-assisted intubating stylet technique often constitutes the most appropriate approach both for daily routine and emergency airway management. Furthermore, we also emphasize the importance of video-assisted intubating stylets in enhancing the practitioner systems response when difficult or failed tracheal intubation is encountered.

Styletubation in Bariatric Surgery: A Case Report

“…Those tracheal intubating modalities include rigid Bullard TM laryngoscope, flexible fiberoptic bronchoscope (FOB), optical stylet [ 36 , 37 , 38 , 39 ], or combined FOB with VL [ 40 ]. The video-assisted intubating stylet technique has recently been termed “styletubation”, in contrast to the concept of the conventional laryngoscopy [ 41 ]. With extensive experience of using styletubation recently in Taiwan, clinicians found this technique useful and easy to learn.…”

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

“…The conventional role of DL and the evolutionary role of VL have been widely studied and discussed. The VS technique has also been extensively described and reported [ 10 ].…”

“…This technique has been demonstrated to be effective in both routine airway management and certain difficult clinical scenarios, including head or neck tumors, morbid obesity, cervical spine immobility, rapid sequence intubation, etc. [ 10 ]. However, according to the current guidelines, it should be mentioned that when a difficult airway (e.g., difficult laryngoscopy, face mask ventilation, emergency invasive airway, etc.)…”

“…Whereas intubation using traditional stylets is a blind or semi-blind technique, “seeing” stylets allow for continuous monitoring of the hypopharynx and airway during the introduction of the tube into the glottis [ 9 ]. The wide clinical application of this video-assisted intubating stylet technique (VS; also known as the Shikani technique) has since been reported in the literature (for a review, see [ 10 ]).…”

“…The VS technique has been widely used in both routine and emergency airway management (on approximately 7000 patients per year in our medical center since 2016), which has been documented in recent clinical reports [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. In most cases, the optic design provides a better visualization of the upper airway pathway ( Figure 1 A,B) and makes the tracheal intubation much easier, smoother, quicker, and less traumatic (for a review, see [ 10 ]).…”