The Flex-It™ Stylet Is Less Effective than a Malleable Stylet for Orotracheal Intubation Using the GlideScope®

Abstract

The GlideScope videolaryngoscope (Verathon Medical, Bothell, WA) usually provides excellent glottic visualization, but directing an endotracheal tube through the vocal cords can be challenging. The goal of the study was to compare the dedicated Flex-It stylet (FIS, Parker Medical, Highlands Ranch, CO) with a malleable stylet, as assessed by time to intubation (TTI). Eighty patients requiring orotracheal intubation for elective surgery were randomly allocated to either the FIS or a malleable stylet (control) to facilitate tracheal intubation using the GlideScope. TTI was recorded by blinded assessors; operators were blinded until after laryngoscopy. The operator assessed the ease of intubation using a 100-mm visual analog scale (0 = easy to 100 = difficult). The number of intubation attempts, number of failures, glottic grades, and use of external laryngeal manipulation were documented. The median TTI was 41 s (interquartile range [IQR] 30-51) for the Flex-It group compared with 32 s (IQR 28-42) for the control group (P = 0.03). The median visual analog scale score for ease of intubation was 20 (IQR 11-39) for the Flex-It group compared with 15 (IQR 8-28) for the control group (P = 0.13). The overall incidence of a Cormack-Lehane Grade I or II glottic view was 100%. In a group of experienced operators using the GlideScope, the FIS was less effective for orotracheal intubation than a malleable endotracheal tube stylet.