Abstract
Purpose
We compare the StyletScope™ fibreoptic stylet (FOS) and the Satin Slip™ conventional metal stylet (CMS), during simulated difficult airway management with manual-in-line stabilization in terms of ease of intubation and esophageal intubation.
Methods
193 patients (ASA I-II, 18–80 yr) were studied in a noncrossover, randomized fashion. Manual-in-line stabilization was applied and the best laryngoscopic view obtained. For the CMS, the primed tracheal tube was advanced under direct vision if Cormack-Lehane grade 1/2, placed behind the epiglottis and advanced blindly if grade 3, and intubation was not attempted if grade 4. For the FOS, the primed tracheal tube was advanced under the direct vision if grade 1/2 and under fibreoptic vision if grade 3/4.
Results
Intubation was successful more frequently (P = 0.02) and required fewer attempts (P = 0.003) with the FOS than the CMS. Intubation with the FOS was successful more frequently (P = 0.02) and required fewer attempts (P = 0.007) than the CMS if grade 3/4. For both stylets, intubation required fewer attempts (P < 0.007) and was quicker (P < 0.0001) for grade 1/2 than 3/4. Esophageal intubation occurred more frequently with the CMS (14 vs 0,P = 0.0001).
Conclusion
Tracheal intubation is more successful, requires fewer attempts and esophageal intubation is less frequent with the FOS than the CMS during cervical spine immobilization using manual-inline axial stabilization. The FOS is a more effective intubation instrument compared to the CMS in patients with simulated cervical spine immobilization.
Résumé
Objectif
Comparer le stylet fibroscopique (SFS) StyletScope ™ et le stylet de métal traditionnel (SMT) Satin Slip™, pour la simulation d’un contrôle difficile des voies aériennes avec stabilisation manuelle en ligne quant à la facilité d’intubation et à l’intubation œsophagienne.
Méthode
L’étude randomisée, non croisée, a porté sur 193 patients (ASA I–II, 18–80 ans). On a appliqué la stabilisation en ligne et obtenu la meilleure vue laryngoscopique. Pour le SFS, le tube endotrachéal amorcé a été avancé sous vision directe avec un grade de Cormack-Lehane de 1/2, placé derrière l’épiglotte et avancé à l’aveugle avec un grade 3 et l’intubation n’a pas été tentée avec un grade 4. Pour le SMT, le tube a été avancé sous vision directe avec un grade 1/2 et sous vision fibroscopique avec un grade 3/4.
Résultats
L’intubation a été réussie plus souvent (P = 0,02) et a demandé moins d’essais (P = 0,003) avec le SFS qu’avec le SMT. Avec un grade 3/4, l’intubation avec le SFS a été réussie plus souvent (P = 0,02) et avec moins d’essais (P = 0,007) qu’avec le SMT. Pour les deux stylets, l’intubation a nécessité peu d’essais (P < 0,007) et a été plus rapide (P < 0,0001) pour un grade 1/2 qu’un grade 3/4. L’intubation œsophagienne est survenue plus souvent avec le SMT (14 vs 0, P = 0,0001).
Conclusion
L’intubation trachéale réussit mieux et en moins d’essais, et l’intubation œsophagienne est moins fréquente, avec le SFS qu’avec le SMT lors de l’immobilisation de la colonne cervicale réalisée avec la stabilisation axiale manuelle en ligne. Le SFS, comparé au SMT, est plus efficace pour l’intubation en cas d’immobilisation simulée de la colonne cervicale.
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Support was received solely from institutional and/or departmental resources. There is no financial relationship between the investigators and the manufacturer of either stylet.
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Kihara, S., Yaguchi, Y., Taguchi, N. et al. The StyletScope™ is a better intubation tool than a conventional stylet during simulated cervical spine immobilization. Can J Anesth 52, 105–110 (2005). https://doi.org/10.1007/BF03018590
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DOI: https://doi.org/10.1007/BF03018590