Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

Abstract

Laryngoscopy for tracheal intubation has been developed for many decades. Among various conventional laryngoscopes, videolaryngoscopes (VLs) have been applied in different patient populations, including difficult airways. The safety and effectiveness of VLs have been repeatedly studied in both normal and difficult airways. The superiority of VLs then has been observed and is advocated as the standard of care. In contrast to laryngoscopy, the development of video-assisted intubating stylet (VS, also named as styletubation) was noticed two decades ago. Since then, sporadic clinical experiences of use have appeared in the literature. In this review article, we presented our vast use experiences of the styletubation (more than 55,000 patients since 2016). We found this technique to be swift (the time to intubate from 3 s to 10 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satisfaction and fast learning curve for the novice trainees) in both normal and difficult airway scenarios. We, therefore, propose that the styletubation technique can be feasibly applied as universal routine use for tracheal intubation.

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.…”

“…Styletubation was conducted with a commercial video intubating stylet which was loaded into an endotracheal tube (Figure 1). Such routine uses of styletubation have been applied in the operating rooms and elsewhere hospital settings (emergency rooms, intensive care units, and general wards) [67]. During the period of last 8 years (from 2016 to 2024), we have practiced the styletubation in both normal airway scenarios and various expected difficult airway scenarios, such as ENT lesions [68], limited cervical spine mobility [69], COVID-19 [70,71], rapid sequence intubation, double-lumen endobronchial tube intubation, pediatric tracheal intubation, trans-nasal tracheal intubation, etc.…”

“…Therefore, VL has been called for use as a first-line tool for routine airway management and be accessible at all times, including application in obese patients [36,95]. In contrast to the potentially dominant and superiority role of VL in the field of airway management, the emerging role of styletubation for tracheal intubation might be in a challenge position in such already leadingposition of VL in the near future [67,96].…”