Shikani Optical Stylet for Awake Nasal Intubation in Patients Undergoing Head and Neck Surgery

Abstract

Objectives To evaluate the efficacy and safety of the Shikani optical stylet (SOS) versus fiberoptic bronchoscope (FOB) for awake nasal intubation in head and neck surgery patients with an anticipated difficult airway. Study Design Prospective randomized clinical trial. Methods This study involved 50 adult patients scheduled for elective head and neck surgery and presented with an anticipated difficult airway. Patients planned for awake nasotracheal intubation were randomly divided into two groups: FOB (n = 25) and SOS (n = 25). Patients were intubated under local anesthesia and sedation using the randomly assigned intubation device by anesthetists proficient in both airway devices. The time to successful intubation was regarded as the primary endpoint. Results The median time (interquartile range) to tracheal intubation in the FOB group was 74 seconds (57–108) and 38 seconds (27–60) in the SOS group (P < .001). Intubation success rates on the first attempt in the FOB and SOS groups were 96% and 92%, respectively (P > .999). Airway assisted maneuvers were required in six (24%) SOS intubations compared to 21 (84%) FOB intubations (P < .001). There were no significant differences between the groups in the incidences of oxygen desaturation and postoperative complications related to intubation. Conclusion Compared to the FOB group, awake nasal intubation in the SOS group required significantly less time and fewer airway‐assisted maneuvers on adult head and neck surgery patients with anticipated difficult airway. Level of Evidence 2 Laryngoscope, 131:319–325, 2021

Airway devices for awake tracheal intubation in adults: a systematic review and network meta-analysis

“…11,12,18,21e29 Cohen's kappa coefficient was 98.3%, demonstrating an almost perfect level of agreement between the authors in the screening process. Details of the screening process are illustrated in Supplementary Appendix B. FBs were compared with OSs, channelled VLs, and unchannelled VLs in three, 11,12,21 one, 29 and seven 18,23e28 trials, respectively, and OSs were compared with unchannelled VLs in one trial. 22 No trials compared DLs to any other airway device.…”

“…The findings of the risk of bias assessment are presented in Figure 1, and only one trial was assessed to be at low risk of bias in all domains. 11 Some concerns in regard to the risk of bias were present in eight trials due to the absence of information on the concealment of the allocation sequence and the lack of evidence of a prespecified methodology for data analysis. 18,21,22,24e27,29 Three trials were at high risk of bias owing to the absence of information relevant to intention-to-treat analyses and the problem of missing outcome data.…”

“…9 OSs are flexible, malleable, or rigid endoscopes that function as stylets for tracheal tubes, 10 and have been found in RCTs to result in similar success rates to FBs in anticipated difficult airways, enabling a shorter time to tracheal intubation (TTI) with no additional adverse effects. 11,12 In deciding whether to choose FBs, DLs, OSs, or channelled or unchannelled VLs for ATI, the conduct of a network meta-analysis would facilitate the simultaneous comparison of these five competing interventions, substituting or supplementing potential direct comparisons, such as that between OSs and unchannelled VLs, with indirect comparisons.…”

Optical Devices in Tracheal Intubation—State of the Art in 2020

“…Those intubated with Shikani stylet experienced shorter intubating time and better hemodynamic stability. This device has also been recently compared with awake nasal fiberoptic intubation in patients with predicted difficult intubation due to head and neck cancer [75]. Both devices scored a similarly high success rates but intubation with Shikani stylet was faster.…”

In Reference to Assessing the Performance of the Shikani Optical Stylet for Awake Nasal Intubation

“…We have great interest in the recent article by Cheng et al 1 comparing the performance of the Shikani optical stylet (SOS) and fibreoptic bronchoscope (FOB) for awake nasal intubation in patients undergoing head and neck surgery. However, we noted several issues in their article on which we invite them to comment.…”