Comparison of Three Tracheal Intubation Techniques in Thyroid Tumor Patients with a Difficult Airway: A Randomized Controlled Trial

Abstract

Objective: To investigate the effectiveness of the Shikani optical stylet (SOS) and GlideScope video laryngoscope (GVL) for tracheal intubation of thyroid tumor patients with a difficult airway. Subjects and Methods: One hundred and twenty thyroid tumor patients with a difficult airway, who were undergoing elective surgery requiring general anesthesia, were enrolled in the study. They were randomly allocated to 3 groups (n = 40 each) who underwent direct laryngoscopy (DL), SOS or GVL. The outcomes recorded were time to intubation, first-attempt success rate, mean artery pressure (MAP), heart rate (HR) and incidence of complications. Results: The mean time to intubation in the SOS group (group S; 42.4 ± 24.1 s) and the GLV group (group G; 29.8 ± 22.3 s) was significantly less than that in the DL group (group D) (68.8 ± 26.6 s). The first-attempt success rate in group S (90.0%) and group G (97.5%) was significantly higher than that in group D (75.0%; all p < 0.05). The HR and MAP at 1 min after intubation were lowest in group S (76.4 ± 9.2 beats/min and 12.9 ± 1.1 kPa), followed by group G (79.9 ± 9.3 beats/min and 13.0 ± 0.9 kPa) and then group D (90.4 ± 8.1 beats/min and 16.6 ± 1.2 kPa). The difference was statistically significant (all p < 0.05). The incidence of lip or mucosal trauma was lowest in group S, followed by group G and then group D. Conclusion: The SOS and the GLV had advantages over the DL in the management of thyroid tumor patients with a difficult airway in terms of a shorter time to intubation, a higher first-attempt success rate and a reduced incidence of complications. Thus, a rational choice of one of these techniques may be better for the perioperative safety of thyroid tumor patients with a difficult airway.