A Randomized Study of Rigid Video Stylet versus Macintosh Laryngoscope for Double-Lumen Endobronchial Tube Intubation Assistance in Thoracoscopic Pulmonary Surgery

Double-lumen endobronchial tube (DLT) intubation is more challenging than single-lumen tube intubation is, and the rigid video stylet (RVS) is one of the tools that has emerged to deal with this demanding intubation procedure. We evaluated whether the UE® RVS can shorten the DLT intubation time and improve the first-attempt intubation success rate compared with that of Macintosh laryngoscope (ML). A total of 130 participants scheduled to undergo thoracoscopic pulmonary surgeries were enrolled. They were randomized to receive either ML- or RVS-assisted DLT intubation. The primary outcomes were the intubation time and first-attempt intubation success rate. The secondary outcomes were the overall intubation success rate, mean arterial pressure, postoperative sore throat (POST), and postoperative hoarseness at 1 h and 24 h. Compared with the ML group, the intubation time was significantly shorter in the RVS group (p < 0.001; 30.82 ± 10.61 vs. 39.62 ± 6.54 s), however, the first-attempt success rate was significantly lower (p = 0.048; 83.08% vs. 95.16%). The POST at 1 h was less severe in the RVS group (p = 0.021). No significant differences were found for the other indicators. Among the patients with normal airways, the UE® RVS can achieve faster DLT intubation and decrease the severity of a POST at 1 h, although it was associated with a lower first-attempt intubation success rate.

[1]  Ł. Szarpak,et al.  A randomized comparison between the VivaSight double-lumen tube and standard double-lumen tube intubation in thoracic surgery patients , 2022, Journal of thoracic disease.

[2]  P. Wieczorek,et al.  Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis , 2021, Journal of clinical medicine.

[3]  K. Sobue,et al.  Effects of the anesthesiologist’s experience on postoperative hoarseness after double-lumen endotracheal tube intubation: a single-center propensity score-matched analysis , 2020, BMC Anesthesiology.

[4]  J. Carlson,et al.  Video versus Direct and Augmented Direct Laryngoscopy in Pediatric Tracheal Intubations. , 2020, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[5]  V. Palvia,et al.  A Randomized Controlled Trial Comparing Laparoscopic Lens Defogging Techniques through Simulation Model , 2018, Gynecology and minimally invasive therapy.

[6]  J. Miner,et al.  Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial , 2018, JAMA.

[7]  S. Min,et al.  A Randomized Controlled Trial Comparing the Utility of Lighted Stylet and GlideScope for Double-Lumen Endobronchial Intubation. , 2017, Journal of cardiothoracic and vascular anesthesia.

[8]  M. El-Tahan,et al.  A Comparison of 3 Videolaryngoscopes for Double-Lumen Tube Intubation in Humans by Users With Mixed Experience: A Randomized Controlled Study. , 2017, Journal of cardiothoracic and vascular anesthesia.

[9]  Anna Lee,et al.  Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. , 2010, The Cochrane database of systematic reviews.

[10]  C. Ting,et al.  A randomised trial comparing real‐time double‐lumen endobronchial tube placement with the Disposcope® with conventional blind placement , 2017, Anaesthesia.

[11]  R. Phillips,et al.  Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates). , 2017, The Cochrane database of systematic reviews.

[12]  L. Berggren,et al.  Time-to-intubation in obese patients. A randomized study comparing direct laryngoscopy and videolaryngoscopy in experienced anesthetists. , 2017, Minerva anestesiologica.

[13]  T. Cook,et al.  Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. , 2016, The Cochrane database of systematic reviews.

[14]  K. El-Boghdadly,et al.  Postoperative sore throat: a systematic review , 2016, Anaesthesia.

[15]  Z. Truszewski,et al.  Double-lumen tube tracheal intubation in a manikin model using the VivaSight Double Lumen: a randomized controlled comparison with the Macintosh laryngoscope. , 2016, The American journal of emergency medicine.

[16]  Z. Truszewski,et al.  Child endotracheal intubation with a Clarus Levitan fiberoptic stylet vs Macintosh laryngoscope during resuscitation performed by paramedics: a randomized crossover manikin trial. , 2015, The American journal of emergency medicine.

[17]  A. Rodríguez-Núñez,et al.  Video rigid flexing laryngoscope (RIFL) vs Miller laryngoscope for tracheal intubation during pediatric resuscitation by paramedics: a simulation study. , 2015, The American journal of emergency medicine.

[18]  H. Seo,et al.  An awake double lumen endotracheal tube intubation using the Clarus Video System in a patient with an epiglottic cyst: a case report , 2014, Korean journal of anesthesiology.

[19]  E. Cho,et al.  Double-lumen tube tracheal intubation using a rigid video-stylet: a randomized controlled comparison with the Macintosh laryngoscope. , 2013, British journal of anaesthesia.

[20]  S. Chou,et al.  Left endobronchial intubation with a double‐lumen tube using direct laryngoscopy or the Trachway® video stylet , 2013, Anaesthesia.

[21]  T. Yamazaki,et al.  The “jaw thrust” maneuver rather than the “BURP” maneuver improves the glottic view for Pentax-AWS assisted tracheal intubation in a patient with a laryngeal aperture , 2010, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[22]  J. Brodsky Lung separation and the difficult airway. , 2009, British journal of anaesthesia.

[23]  W. Karzai,et al.  Hypoxemia during One-lung Ventilation: Prediction, Prevention, and Treatment , 2009, Anesthesiology.

[24]  P. Kranke,et al.  Comparison of the Glidescope® and Airtraq® optical laryngoscopes in patients undergoing direct microlaryngoscopy , 2009, Anaesthesia.

[25]  S. Do,et al.  Prophylactic Dexamethasone Decreases the Incidence of Sore Throat and Hoarseness After Tracheal Extubation with a Double-Lumen Endobronchial Tube , 2008, Anesthesia and analgesia.

[26]  T. Turkstra,et al.  Cervical Spine Motion: A Fluoroscopic Comparison During Intubation with Lighted Stylet, GlideScope, and Macintosh Laryngoscope , 2005, Anesthesia and analgesia.

[27]  B. Seifert,et al.  Complaints of sore throat after tracheal intubation: a prospective evaluation , 2005, European journal of anaesthesiology.

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

[29]  J. Katz,et al.  The Incidence of Class “Zero” Airway and the Impact of Mallampati Score, Age, Sex, and Body Mass Index on Prediction of Laryngoscopy Grade , 2001, Anesthesia and analgesia.

[30]  I. Takenaka,et al.  Jaw thrust maneuver for endotracheal intubation using a fiberoptic stylet. , 2000, Anesthesia and analgesia.

[31]  J. Caldwell,et al.  Rapid tracheal intubation with rocuronium: a probability approach to determining dose. , 1999, Anesthesiology.

[32]  S. Catling,et al.  Hoarseness after tracheal intubation , 1992, Anaesthesia.