Effects of tip‐manipulated stylet angle on intubation using the GlideScope^® videolaryngoscope in children: A prospective randomized controlled trial

Abstract

Background An optimal endotracheal tube curve can be a key factor in successful intubation using the GlideScope videolaryngoscope. Aims This study aimed to evaluate the effects of tube tip‐modified stylet curve on the intubation time in children. Methods Children aged 1‐5 years were randomly assigned to either the standard curve (group S, n = 60) or tip‐modified curve (group T, n = 60) groups. In group S, the endotracheal tube curve was similar to that in the GlideScope. In group T, a point approximately 1.5 cm from the tube tip was additionally angled to the left by 15°‐20°. The primary outcome was the total intubation time, and the secondary outcomes were incidence of successful intubation in the first attempt, number of additional manipulations of the stylet curve, and visual analog scale (VAS) score for the easiness of intubation. Results The mean total intubation time was significantly longer in group S than that in group T (13.9 [10.8] vs. 9.0 [3.4] sec, mean difference, 4.9 s; 95% confidence interval [CI], 2.0‐7.8; p = .001). All patients in group T were successfully intubated in the first attempt, whereas those in group S were not (100% vs. 93.3%, relative risk [RR], 0.11; 95% CI, 0.01‐2.02; p = .1376). Three patients in group S could be intubated after modifying the ETT curve similar to that in group T. Operators reported that tracheal intubation was easier in group T than in group S (median [interquartile range] for VAS; 1 [1‐2] vs. 2 [1‐3]; p < .001). Conclusions Having additional angle of the endotracheal tube tip to the left could be a useful technique to facilitate directing and advancing endotracheal tube into the vocal cords.

Airway management in neonates and infants

“…This can result in more time needed for tracheal intubation and lower overall success rates, especially in small children 71,72,78–84 . Modification of the shape of a stylet by adding an angle of 15 degrees has been described when using a hyperangulated blade 85,86 …”

“… 71 , 72 , 78 – 84 Modification of the shape of a stylet by adding an angle of 15 degrees has been described when using a hyperangulated blade. 85 , 86 …”

“…71,72,[78][79][80][81][82][83][84] Modification of the shape of a stylet by adding an angle of 15 degrees has been described when using a hyperangulated blade. 85,86 Based on this evidence, other alternative techniques that have been studied in this population for tracheal intubation when direct laryngoscopy is difficult include flexible bron-choscopy, intubation through a supraglottic airway device, or combined use of videolaryngoscopy with flexible bronchoscopy. Data from the Pediatric Difficult Intubation Registry suggest that these advanced techniques have similar success rates, and it is not possible to recommend any single technique.…”

Usefulness of C-curved stylet for intubation with the C-MAC® Miller videolaryngoscope in neonates and infants: a prospective randomized controlled trial

“…Moreover, multiple consecutive intubation attempts may contribute to increased morbidity [ 1 ]. Therefore, the identification of an optimal regimen for successful intubation in the minimum time for small children is of paramount importance [ 4 ].…”

“…Furthermore, even a small motion generated by the operator makes the ETT move significantly in the glottis view of the device. Therefore, optimizing the ETT shape to facilitate operator handling constitutes an important factor for successful tracheal intubation over a short time [ 4 , 8 ]. In adult patients, a 90°-angled hockey-stick-shaped stylet could facilitate successful intubation using a videolaryngoscope.…”