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: According to the 2022 American Society of Anesthesiologists (ASA) guidelines on difficult airway management, video laryngoscope, video stylet, and flexible videoscope are recommended for intubation of complex difficult airways. Here we compare the advantages of three airway devices when intubating patients with difficult airways. METHODS: For a comparative study on transoral intubation, 170 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: A total of 177 patients were enrolled, 59 of whom were randomized to each group. 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 the difference in the first-pass intubation success rate between Groups VS and FV was not significant(P>0.05). The number of patients categorized as Wilson-Cormack-Lehane(W-C-L) class I-II was lower in Group VL than in Groups VS and FV (77.97% vs. 98.30% vs. 100%, P=0.0281). The mean time to intubation was 44.56 ± 4.42 seconds in Group VL, 26.88 ± 4.51 seconds in the Group VS and 95.20 ± 4.01 seconds in Group FV, and the time to tracheal intubation was significantly longer in Group FV than in Groups VL and VS. Obviously, the Group VS had a significant advantage in intubation time (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. Prospective registration.