Abstract
BackgroundA tracheal tube stylet can be used to assist successful tracheal intubation, especially during videolaryngoscopic intubation because videolaryngoscopes with a Macintosh-type blade such as McGrath® MAC videolaryngoscope have more acute angle than conventional Macintosh laryngoscope. However, the use of a stylet during tracheal intubation can raise concerns about stylet-induced postoperative airway complications, such as sore throat, subglottic injury, and hoarseness. In this study, we compared the incidence of postoperative airway complications after McGrath® MAC videolaryngoscopic intubation with versus without a stylet in patients with a high Mallampati score.MethodsIn 104 patients with Mallampati score III or IV and who were scheduled for lumbar or thoracic spine surgery, McGrath® MAC videolaryngoscopic intubation was performed either with a stylet (group S, n = 52) or without a stylet (group N, n = 52). The primary outcome measure was the incidences of sore throat evaluated at 1 and 24 h postoperatively. Secondary outcome measures were the incidences of subglottic injury and postoperative hoarseness.ResultsThe incidence of CL grade III in group S and N was 3.8 and 5.8%, respectively. No patient showed CL grade IV. The incidences of sore throat at 1 (26.9 vs 19.2%, P = 0.485) and 24 h (17.3 vs 13.5%, P = 0.786, respectively) postoperatively were not significantly different between the group S and N. However, the incidence of subglottic injury was significantly higher in the group S, compared with the group N (65.4 vs 42.3%, P = 0.030). The incidence of postoperative hoarseness did not differ significantly between the two groups.ConclusionsThe use of a stylet during McGrath® MAC videolaryngoscopic intubation did not have a significant impact on the incidence of postoperative sore throat in patients with a high Mallampati score. Avoiding the use of a stylet during intubation with McGrath® MAC videolaryngoscope may reduce the incidence of subglottic injury in such patients.Trial registrationClinical Research Information Service (identifier: KCT0002427, date of registration: June 12, 2017).
Highlights
A tracheal tube stylet can be used to assist successful tracheal intubation, especially during videolaryngoscopic intubation because videolaryngoscopes with a Macintosh-type blade such as McGrath® MAC videolaryngoscope have more acute angle than conventional Macintosh laryngoscope
Tracheal intubation without a stylet during direct laryngoscopy significantly reduced the incidence of postoperative pharyngeal pain, which implied that the application of a stylet itself could affect the development of postoperative sore throat [4]
One patient’s trachea in the group N was not intubated even after three intubation attempts, because the inlet of the vocal cord was not visible due to the anteriorly located larynx. The trachea of this patient was intubated successfully by using McGrath® MAC videolaryngoscopy-assisted a lighted stylet with the classic “hockey-stick” shape
Summary
A tracheal tube stylet can be used to assist successful tracheal intubation, especially during videolaryngoscopic intubation because videolaryngoscopes with a Macintosh-type blade such as McGrath® MAC videolaryngoscope have more acute angle than conventional Macintosh laryngoscope. The use of a stylet during tracheal intubation can raise concerns about stylet-induced postoperative airway complications, such as sore throat, subglottic injury, and hoarseness. We compared the incidence of postoperative airway complications after McGrath® MAC videolaryngoscopic intubation with versus without a stylet in patients with a high Mallampati score. In cases of videolaryngoscopic intubation, a prior investigation reported that repeated attempts with a styletted endotracheal tube during tracheal intubation with GlideScope® (Verathon Medical, Bothell, WA, USA) significantly increased the incidence of postoperative sore throat in patients with normal airway [6]. One small prospective study conducted by Shimazaki and co-workers showed positive correlation between the use of a stylet during McGrath® MAC videolaryngoscopic intubation and postoperative sore throat in patients without difficult airway [7]. It was necessary to investigate the relationship between the use of a stylet during videolaryngoscopic intubation and postoperative sore throat in patients with a high Mallampati score
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