Comparison of the success rate of tracheal intubation between stylet and bougie with a hyperangulated videolaryngoscope: a randomised controlled trial

Abstract

SummaryHyperangulated videolaryngoscopes are known to increase the success rate of tracheal intubation in the setting of difficult airway management when used with a stylet or bougie. However, there is controversy over which adjunct is more useful. This randomised study aimed to compare first attempt tracheal intubation success rate between a stylet and bougie when using a hyperangulated videolaryngoscope. We recruited patients aged > 20 years who were scheduled for elective surgery under general anaesthesia and required tracheal intubation. We only included patients with factors predicting difficult tracheal intubation based on pre‐anaesthesia airway evaluation. Tracheal intubation was attempted using a Glidescope® with either a stylet or bougie as an adjunct according to group assignment. Primary outcome was the success rate of the first tracheal intubation attempt, and secondary outcomes were success of second and third attempts; tracheal intubation time; and occurrence of sore throat, dysphagia or hoarseness. A total of 166 patients were included. The success rate of the first tracheal intubation attempt was significantly higher in patients allocated to the bougie group compared with those allocated to the stylet group (81/83 (98%) vs. 73/83 (88%), respectively; p = 0.032). The number of patients who needed two attempts was significantly lower in those allocated to the bougie group compared with those allocated to the stylet group (1/83 (1%) vs. 9/83 (11%), respectively; p = 0.018). Each group had one patient (1%) where tracheal intubation was achieved after a third attempt. There was no significant difference in the occurrence of sore throat, dysphagia and hoarseness between the two groups. When difficult tracheal intubation is anticipated and a hyperangulated videolaryngoscope is used, the success rate of the first attempt is higher when a bougie is used compared with a stylet.

Stylets, bougies and hyperangulated videolaryngoscopy

“…I enjoyed the article by Eum et al [1], but as a very regular user of hyperangulated videolaryngoscopy, I am surprised by the results.…”

“…We would like to thank Cook [1] for his interest in our research [2] and the opportunity to further discuss the use of hyperangulated videolaryngoscopes and their adjuncts.…”

Intubation aids in hyperangulated videolaryngoscopy: essential components more than just adjuncts

“…We thank Drs Cafferkey and Ward [1] for their interest in our article [2]. To address the comment on the stylet's shape, we acknowledge its significance, as it substantially impacts the success of tracheal intubation.…”

Intubation aids in hyperangulated videolaryngoscopy: essential components more than just adjuncts: a reply

“…In this study, oral morphine was prescribed as required and intravenous morphine was supplemented for severe pain. Although 1 mg of intravenous morphine is equivalent to 3 mg by the oral route [2], and the recommended minimal clinically important difference of cumulative opioid consumption for postoperative analgesia is an absolute reduction of 10 mg intravenous morphine in 24 h [3], the study does not mention whether reported 24 h cumulative morphine consumption was oral or intravenous.…”

“…We thank Drs Cafferkey and Ward [1] for their interest in our article [2]. To address the comment on the stylet's shape, we acknowledge its significance, as it substantially impacts the success of tracheal intubation.…”