Comparison of Simple Stylet versus Lighted Stylet for Intubating the Trachea with a Direct Laryngoscope: A Randomized Clinical Trial

This study investigated the effectiveness of a lighted stylet during tracheal intubation with direct laryngoscopy. The study randomly assigned 284 patients undergoing general anesthesia to either the simple stylet (Group S) or lighted stylet (Group L) groups. In both groups, stylet-assisted intubation was performed with direct laryngoscopy. In group S, a simple stylet was used and removed when the tip of the endotracheal tube was thought to have passed the larynx. In Group L, a lighted stylet was used and removed after confirming transillumination of the suprasternal notch. The success rate at the first attempt, total intubation time, incidence of mucosal bleeding, and severity of postoperative sore throat were compared. Compared to a simple stylet, the lighted stylet significantly increased the success rate of tracheal intubation at the first attempt (128 (90%) vs. 140 (99%), p = 0.003, Groups S and L, respectively). The incidence of mucosal bleeding was significantly higher in Group S (35 (25%) vs. 19 (13%), p = 0.011, Groups S and L, respectively). The total intubation time and degree of postoperative sore throat were not significantly different between the two groups. A lighted stylet increased the success rate of tracheal intubation during stylet-assisted tracheal intubation with direct laryngoscopy.

[1]  Cai-neng Wu,et al.  Laryngoscope and a New Tracheal Tube Assist Lightwand Intubation in Difficult Airways due to Unstable Cervical Spine , 2015, PloS one.

[2]  J. Sakles,et al.  A comparison of the C-MAC video laryngoscope to the Macintosh direct laryngoscope for intubation in the emergency department. , 2012, Annals of emergency medicine.

[3]  W. Luo,et al.  Optimal Bent Length of Lightwand for Intubation in Adults: A Randomized, Prospective, Comparative Study , 2012, The Journal of international medical research.

[4]  R. Noppens,et al.  Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: A prospective, comparative study in the ICU , 2012, Critical Care.

[5]  R. Levitan,et al.  The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices. , 2011, Annals of emergency medicine.

[6]  O. Nofal.  Awake light-aided blind nasal intubation: prototype device. , 2010, British Journal of Anaesthesia.

[7]  J. Scholz,et al.  Management of the predicted difficult airway: a comparison of conventional blade laryngoscopy with video-assisted blade laryngoscopy and the GlideScope , 2010, European journal of anaesthesiology.

[8]  D. Healy,et al.  The use of the BERCI DCI® Video Laryngoscope for teaching novices direct laryngoscopy and tracheal intubation * , 2008, Anaesthesia.

[9]  T. Mort,et al.  Esophageal intubation with indirect clinical tests during emergency tracheal intubation: a report on patient morbidity. , 2005, Journal of clinical anesthesia.

[10]  P. Ko,et al.  Tracheal rupture complicating emergent endotracheal intubation. , 2004, The American journal of emergency medicine.

[11]  T. Fuchs-Buder,et al.  Laryngeal Morbidity and Quality of Tracheal Intubation: A Randomized Controlled Trial , 2003, Anesthesiology.

[12]  Getúlio Rodrigues de Oliveira Filho,et al.  The Construction of Learning Curves for Basic Skills in Anesthetic Procedures: An Application for the Cumulative Sum Method , 2002, Anesthesia and analgesia.

[13]  F. Agrò,et al.  Efficacy of a combined technique using the Trachlight™ together with direct laryngoscopy under simulated difficult airway conditions in 350 anesthetized patients , 2002, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[14]  C. Baillard,et al.  Randomized Study Comparing the “Sniffing Position” with Simple Head Extension for Laryngoscopic View in Elective Surgery Patients , 2001, Anesthesiology.

[15]  D. Bourke,et al.  Use of the lighted stylet to aid direct laryngoscopy. , 1997, Anesthesiology.

[16]  O. Hung,et al.  Clinical Trial of a New Lightwand Device (Trachlight) to Intubate the Trachea , 1995, Anesthesiology.

[17]  M. Heller,et al.  Use of a lighted stylet to confirm correct endotracheal tube placement. , 1987, Chest.

[18]  R S Cormack,et al.  Difficult tracheal intubation in obstetrics , 1983, Anaesthesia.

[19]  R. Macintosh,et al.  Illuminated introducer for endotracheal tubes , 1957, Anaesthesia.