Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis

Abstract

Background: Although minimization of cervical spine motion by using a neck collar or manual in-line stabilization is recommended for urgent tracheal intubation (TI) in patients with known or suspected cervical spine injury (CSI), it may worsen glottic visualization. The overall performance of video-stylets during TI in patients with neck immobilization remains unclear. The current meta-analysis aimed at comparing the intubation outcomes of different video-stylets with those of conventional laryngoscopes in patients with cervical immobilization. Method: The databases of Embase, Medline, and the Cochrane Central Register of Controlled Trials were searched from inception to June 2021 to identify trials comparing intubation outcomes between video-stylets and conventional laryngoscopes. The primary outcome was first-pass success rate, while secondary outcomes included overall success rate, time to intubation, the risk of intubation-associated sore throat, or tissue damage. Results: Five randomized controlled trials published between 2007 and 2013 involving 487 participants, all in an operating room setting, were analyzed. The video-stylets investigated included Bonfils intubation fiberscope, Levitan FPS Scope, and Shikani optical stylet. There was no difference in first-pass success rate (risk ratio [RR] =1.08, 95% confidence interval [CI]: 0.89–1.31, P = .46], overall success rate (RR = 1.06, 95% CI: 0.93–1.22, P = .4), intubation time [mean difference = 4.53 seconds, 95% CI: –8.45 to 17.51, P = .49), and risk of tissue damage (RR = 0.46, 95% CI: 0.16–1.3, P = .14) between the 2 groups. The risk of sore throat was lower with video-stylets compared to that with laryngoscopes (RR = 0.45, 95% CI: 0.23–0.9, P = .02). Conclusion: Our results did not support the use of video-stylets as the first choice for patients with neck immobilization. Further studies are required to verify the efficacy of video-stylets in the nonoperating room setting.

General anesthesia but not conscious sedation improves functional outcome in patients receiving endovascular thrombectomy for acute ischemic stroke: A meta-analysis of randomized clinical trials and trial sequence analysis

“…Cochrane Review Manager (RevMan 5.3; Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration, 2014) was used for data synthesis. Risk ratios (RRs) or mean difference (MD) with 95% confidence intervals (CIs) were calculated based on a random effects model assuming heterogeneity across studies ( 20 , 21 ). Heterogeneity was assessed with I 2 statistics [i.e., low ( I 2 < 50%), moderate ( I 2 = 50–75%), and high ( I 2 > 75%)].…”

Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

“…In contrast, the role of styletubation for universal and routine tracheal intubation has never been studied or reported. A recent meta-analysis does not support the use of video stylets as the first choice for patients with neck immobilization [193]. Contradicted results from a meta-analysis study validated efficacy of video stylets (and VL) for tracheal intubation in the situation of cervical spine immobilization [194].…”

A test prototype of a novel flexible video laryngoscope and preliminary verification in a difficult airway management simulator

“…Another type of laryngoscope is the visual rigid laryngoscope, which mainly includes the Trachway video intubating stylet, Levitan FPS optical stylet, MultiViewScope, Optiscope video stylet, etc. [ 14 – 18 ]. As a tool for guiding intubation in endotracheal tubes, the visual field is relatively small, and sometimes it is difficult to identify the structure of the pharyngeal cavity.…”