Comparison of video laryngoscope, video stylet, and flexible videoscope for transoral endotracheal intubation in patients with difficult airways: a randomized, parallel-group study

Abstract

Background The 2022 ASA guidelines recommend the video laryngoscope, video stylet, and flexible videoscope as airway management tools. This study aims to compare the efficacy of three airway devices in intubating patients with difficult airways. Methods A total of 177 patients were selected and randomized into the following three groups: the video laryngoscope group (Group VL, n = 59), video stylet group (Group VS, n = 59), and flexible videoscope group (Group FV, n = 59). The success rate of the first-pass intubation, time of tracheal intubation, level of glottic exposure, and occurrence of intubation-related adverse events were recorded and analyzed. Results All patients were successfully intubated with three devices. The first-pass intubation success rate was significantly higher in Groups VS and FV than in Group VL (96.61% vs. 93.22% vs. 83.05%, P < 0.01), but it was similar in the first-pass intubation success rate between Groups VS and FV(P > 0.05). The number of patients categorized as Wilson-Cormack-Lehane grade I-II was fewer in Group VL than in Groups VS and FV (77.97% vs. 98.30% vs. 100%, P = 0.0281). The time to tracheal intubation was significantly longer in Group FV(95.20 ± 4.01) than in Groups VL(44.56 ± 4.42) and VS(26.88 ± 4.51) (P < 0.01). No significant differences were found among the three groups in terms of adverse intubation reactions (P > 0.05). Conclusions In patients with difficult airways requiring intubation, use of the video stylet has the advantage of a relatively shorter intubation time, and the flexible videoscope and video stylet yield a higher first-pass intubation success rate and clearer glottic exposure than the use of the video laryngoscope. Trial registration Chinese Clinical Trial Registry. No: ChiCTR2200061560, June 29, 2022.

Use of the Disposcope endoscope for awake orotracheal intubation in an elderly patient with a large vocal cord polyp -a case report-

“…However, video laryngoscopy may not be appropriate for patients with limited mouth opening capacity or cervical spinal injuries. A recent study comparing the efficacy of flexible videoscopes, video laryngoscopes, and video stylets for orotracheal intubation under general anesthesia in patients with difficult airways found that video stylets and flexible videoscopes yielded higher rates of successful first-attempt intubations and better glottic exposure than video laryngoscopes [ 8 ]. Additionally, the use of video stylets for endotracheal intubation resulted in a significant reduction in intubation time compared with both the video laryngoscope and flexible videoscope.…”

“…However, the Disposcope endoscope does have some limitations, such as the lack of a working channel for suctioning secretions, which may compromise visualization if considerable secretions are present. This limitation can be overcome by positioning the lens at the Murphy’s orifice of the tracheal tube without moving the lens over the tip and by improving the operational skill [ 8 ]. Although Disposcope endoscopes have recently been used for awake nasotracheal intubation [ 10 ], to date, reports on the use of Disposcope endoscope for awake orotracheal intubation are limited.…”

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

“…We have demonstrated, in this article, that styletubation serves well for such goal of tracheal intubation in this particular clinical scenario (Table 2). With the increasing attention at the styletubation technique in various clinical scenarios [67,96,[106][107][108], we believe the potential clinical role of styletubation will eventually supersede that of laryngoscopy in the near future. In conclusion, in obese patients undergoing bariatric surgery, the role of routine application of styletubation is promising and worthy to test.…”