Stylet Group Research Articles

Mid‐term outcomes of delivery catheter‐based and stylet‐based right ventricular septal pacing: Follow‐up results from a multicenter, prospective, randomized study

AbstractBackgroundThe Mt FUJI study was a multicenter, prospective, randomized, single‐blind, controlled trial comparing delivery catheter‐based and stylet‐based right ventricular (RV) lead placement at the RV septum. This study extended the follow‐up duration to 1 year after implantation.MethodsSeventy patients with pacemaker indications for atrioventricular block were randomly assigned to the delivery catheter and stylet groups. We compared the mid‐term efficacy and safety between the two groups at 1 year after implantation. The primary outcome was the change in the left ventricular ejection fraction (LVEF), and the secondary outcomes were changes in brain natriuretic peptide (BNP) levels, lead parameters, paced QRS duration, and the incidence of adverse events.ResultsAt the 1‐year follow‐up, no significant differences were observed in the changes in the LVEF (+1.0% ± 8.6% vs. +3.1% ± 8.1%, p = .332), BNP levels (+8.0 [−11.1, 26.5] pg/mL vs. −8.7 [−15.3, 13.2] pg/mL, p = .193), or lead performance between the delivery catheter and stylet groups. The QRS duration was significantly shorter in the delivery catheter group than in the stylet group (128 ± 23 ms vs. 146 ± 17 ms, p < .001). All‐cause death, hospitalization for heart failure, new development of atrial fibrillation, and pacing‐induced cardiomyopathy occurred in seven patients in the delivery catheter group and five in the stylet group.ConclusionThe delivery catheter system was similarly useful and safe compared to the stylet system in the mid‐term follow‐up from the Mt FUJI trial. Further long‐term evaluations are warranted.

Comparison of the success rate of tracheal intubation between stylet and bougie with a hyperangulated videolaryngoscope: a randomised controlled trial.

Hyperangulated videolaryngoscopes are known to increase the success rate of tracheal intubation in the setting of difficult airway management when used with a stylet or bougie. However, there is controversy over which adjunct is more useful. This randomised study aimed to compare first attempt tracheal intubation success rate between a stylet and bougie when using a hyperangulated videolaryngoscope. We recruited patients aged > 20 years who were scheduled for elective surgery under general anaesthesia and required tracheal intubation. We only included patients with factors predicting difficult tracheal intubation based on pre-anaesthesia airway evaluation. Tracheal intubation was attempted using a Glidescope® with either a stylet or bougie as an adjunct according to group assignment. Primary outcome was the success rate of the first tracheal intubation attempt, and secondary outcomes were success of second and third attempts; tracheal intubation time; and occurrence of sore throat, dysphagia or hoarseness. A total of 166 patients were included. The success rate of the first tracheal intubation attempt was significantly higher in patients allocated to the bougie group compared with those allocated to the stylet group (81/83 (98%) vs. 73/83 (88%), respectively; p = 0.032). The number of patients who needed two attempts was significantly lower in those allocated to the bougie group compared with those allocated to the stylet group (1/83 (1%) vs. 9/83 (11%), respectively; p = 0.018). Each group had one patient (1%) where tracheal intubation was achieved after a third attempt. There was no significant difference in the occurrence of sore throat, dysphagia and hoarseness between the two groups. When difficult tracheal intubation is anticipated and a hyperangulated videolaryngoscope is used, the success rate of the first attempt is higher when a bougie is used compared with a stylet.

Comparison of video laryngoscope, video stylet, and flexible videoscope for transoral endotracheal intubation in patients with difficult airways: a randomized, parallel-group study

BackgroundThe 2022 ASA guidelines recommend the video laryngoscope, video stylet, and flexible videoscope as airway management tools. This study aims to compare the efficacy of three airway devices in intubating patients with difficult airways.MethodsA total of 177 patients were selected and randomized into the following three groups: the video laryngoscope group (Group VL, n = 59), video stylet group (Group VS, n = 59), and flexible videoscope group (Group FV, n = 59). The success rate of the first-pass intubation, time of tracheal intubation, level of glottic exposure, and occurrence of intubation-related adverse events were recorded and analyzed.ResultsAll patients were successfully intubated with three devices. The first-pass intubation success rate was significantly higher in Groups VS and FV than in Group VL (96.61% vs. 93.22% vs. 83.05%, P < 0.01), but it was similar in the first-pass intubation success rate between Groups VS and FV(P > 0.05). The number of patients categorized as Wilson-Cormack-Lehane grade I-II was fewer in Group VL than in Groups VS and FV (77.97% vs. 98.30% vs. 100%, P = 0.0281). The time to tracheal intubation was significantly longer in Group FV(95.20 ± 4.01) than in Groups VL(44.56 ± 4.42) and VS(26.88 ± 4.51) (P < 0.01). No significant differences were found among the three groups in terms of adverse intubation reactions (P > 0.05).ConclusionsIn patients with difficult airways requiring intubation, use of the video stylet has the advantage of a relatively shorter intubation time, and the flexible videoscope and video stylet yield a higher first-pass intubation success rate and clearer glottic exposure than the use of the video laryngoscope.Trial registrationChinese Clinical Trial Registry. No: ChiCTR2200061560, June 29, 2022.

The effect of the use of a stylet and/or McGrath videolaryngoscope on intubation time in obese patients: A randomized clinical trial

BackgroundObese people have low oxygen reserves because of low functional capacity. For this reason, the time for airway manipulation before intubation is reduced and airway management may be difficult in obese population. AimThe purpose of the present study was to investigate whether videolaryngoscope or stylet or both, shorten the intubation time in obese patients. MethodsA total of 120 obese patients scheduled for surgery under general anesthesia were included in the study, 30 in each group; Group DL utilizing a standardized Macintosh blade, Group DLS: DL utilizing a standardized Macintosh blade + Stylet, Group VL: McGrath VL (Series 5), Group VLS: McGrath VL (Series 5) + Stylet. Intubation time was investigated as the primary outcome. ResultsIntubation times were found to be significantly different between the study groups (P < 0.001). According to the Post-Hoc Test results, the intubation time of Group DL was significantly lower than the intubation time of Group VL and Group VLS (P < 0.001, P = 0.014, respectively). Group DLS intubation time was significantly lower than those of Group VL and Group VLS (P < 0.001, P < 0.001, respectively). Intubation times were similar between the other groups (P > 0.05). ConclusionsThe intubation times of obese patients were shorter with direct laryngoscopy, with or without a stylet when compared to those with a McGrath videolaryngoscope, with or without a stylet. Among the same type of laryngoscopy groups, the use of stylet did not change the intubation time. The rate of first-pass intubation was lower with the stylet-free McGrath videolaryngoscope when compared to direct laryngoscopy and direct laryngoscopy plus stylet groups.

Actual conditions of atrial septal lead implantation and the factors related to successful implantation

BackgroundPacemaker leads were originally implanted into the right atrial appendage (RAA) and right ventricular apex, but septal pacing, which is more physiological, is becoming increasingly popular. The usefulness of atrial lead implantation in the RAA or atrial septum is inconclusive, and whether or not atrial septum implantation is accurate has not yet been verified. MethodsPatients who underwent pacemaker implantation between January 2016 and December 2020 were included. The success rate of atrial septal implantation was validated using thoracic computed tomography performed for any reason postoperatively. We examined factors related to the successful implantation of the atrial lead in the atrial septum. ResultsForty-eight people were included in this study. Lead placement was performed with a delivery catheter system (SelectSecure MRI SureScan; Medtronic Japan Co., Ltd., Tokyo, Japan) in 29 cases and a conventional stylet in 19 cases. The mean age was 74 ± 12 years old, and 28 (58%) were male. Successful atrial septal implantation was performed in 26 patients (54%), with only 4 (21%) successful implantations in the stylet group. There were no significant differences in the age, gender, body mass index (BMI), pacing P wave axis, duration, or amplitude between the atrial septal implantation group and non-septal groups. The only significant difference was for delivery catheter use [22 (85%) vs. 7 (32%), p < 0.001]. In multivariate logistic analysis, the use of a delivery catheter was independently associated with successful septal implantation [odds ratio (OR): 16.9, 95% confidence interval 3.0–90.9] after adjusting for the age, gender, and BMI. ConclusionThe success rate of atrial septal implantation was very low at 54%, and only the use of a delivery catheter was associated with successful septal implantation. However, even with a delivery catheter, the success rate was 76%, so further investigations are warranted.

Comparison between stylet and bougie with the C-MAC D-blade in cervical simulated immobility. A prospective randomized controlled trial

Introduction: The C-MAC D-blade was designed for difficult airway intubation scenarios. To facilitate easier and faster endotracheal intubation in the laryngoscopy paradox, an introducer is preferred. Hence, we decided to conduct a study to compare the 60˚ angled C-MAC stylet and the gum elastic bougie as aids to intubation while using the C-MAC D-blade laryngoscope in a simulated difficult airway setting. Objective: To compare the ease of oral intubation with the use of the C-MAC stylet (60˚ angled stylet) versus intubation performed over a bougie inserted using the C-MAC D-blade guidance in patients with simulated restricted cervical mobility. Methods: Prospective, randomized controlled single-center study. Intubation using the C-MAC D-blade laryngoscope was performed in 48 surgical patients randomly assigned to 2 groups of 24 each: Stylet group, Group S (using 60˚ angled stylet) and Bougie group, Group B (using bougie) after providing manual in-line stabilization to restrict cervical mobility. The Mann-Whitney U test and the Chi square test were used as applicable. Results: The use of stylet resulted in easier (Group S 75% vs. Group B 16.7%) and faster (Group S 26.83 ± 8.61s vs. Group B 47.18 ± 16.46s) intubation with fewer attempts compared to group B. Both groups experienced a similar hemodynamic stress response to intubation. Conclusions: The 60˚ angled C-MAC Stylet is a more effective and time-saving intubation aid with C-MAC D-blade compared to bougie.

840: TO BOUGIE OR NOT TO BOUGIE: META-ANALYSIS COMPARING FIRST-ATTEMPT INTUBATION WITH BOUGIE AND STYLET

Introduction: Endotracheal intubation is a life-saving procedure with several indications. Successful placement of the endotracheal tube on the first attempt greatly reduces the risk of complications. The endotracheal introducer (commonly known as the bougie) and the stylet are two different devices used to facilitate orotracheal intubations in various settings. The aim of this systematic review and meta-analysis is to compare the likelihood of successful first attempt intubation using either of the two devices. Methods: A search was performed on PubMed, Cochrane, and Web of Science. We used the following mesh terms, “(endotracheal intubation) OR (orotracheal intubation) AND (bougie) OR (gum elastic bougie) OR (endotracheal introducer) OR (stylet)” from the 01/01/2000 to 07/15/2022. We screened 3100 articles out of which 4 randomized controlled trials comparing the use of bougie and stylet were included in this systematic review. Studies performed on cadavers/mannequins, population age less than 18, and out-of-hospital intubations were excluded from this review. Results: This systematic review and meta-analysis consisted of 4 randomized controlled trials with a total population of 1962. The mean age for the bougie group was 52.7 years and the stylet group was 52.8 years. The average body mass index for the bougie and stylet groups was 26.8 Kg/m2 and 27.1 Kg/m2, respectively. When a random effects model was applied, the metanalysis did not show any significant differences in the first attempt success rate with a risk ratio of 0.957; 95% confidence interval, 0.833 to 1.100. Reported complications included hypoxemia, esophageal intubation, pneumothorax, and cardiovascular collapse with no significant differences in the two groups. Conclusions: The bougie and stylet had comparable rates of first attempt intubation with neither being superior to the other. The healthcare provider should take into consideration their ease and comfort of intubation with each technique before opting for one during intubation.

Comparison between gum elastic bougie and malleable stylet as aids to intubation during application of cricoid pressure: a prospective randomised controlled study

Background: Rapid sequence intubation with application of cricoid pressure is widely practiced in all emergency situations to prevent aspiration of gastric contents. Stylet or gum elastic bougie is used as intubation aid for rapidly securing the airway. Aim: To compare gum elastic bougie and malleable stylet as aids for endotracheal intubation during application of cricoid pressure. Results: Endotracheal intubation was successful in the first attempt in all of the 60 patients enrolled in the study. Time taken for laryngoscopy and intubation was clinically similar in both the groups of patients. However, in the stylet group, successful ET intubation was achieved in about 7 sec less when compared to the bougie group (p&lt; 0.05). Ease of intubation as compared using the Visual Analogue Scale (VAS) Score was similar in both groups. Laryngeal view improved in 22 patients of 60 patients (36.66%) after application of cricoid pressure, while it remained the same as before in 22. Overall, the grade remained the same or improved after cricoid pressure in 73.3% of patients. The laryngeal view worsened in 16 patients (27.7%). Conclusion: Gum elastic bougie and stylet are equally effective intubation aids during rapid sequence intubation. Intubation aided by bougie takes more time than that of a stylet, even though it is clinically trivial. Cricoid pressure does not affect the laryngoscopic visualisation of glottis in majority of patients

Trachway® flexible stylet facilitates the correct placement of double-lumen endobronchial tube: a prospective, randomized study

BackgroundThe mainstream facilitation of one-lung ventilation is using double-lumen endobronchial tubes. However, it is more difficult to be positioned properly and more likely to cause airway injuries. How to place double-lumen endobronchial tubes rapidly and correctly is important for thoracic anesthesiologists.MethodsOne hundred eight patients with an American Society of Anesthesiologists physical status of I to III were 20 years of age or over, and required one-lung ventilation for thoracic surgery. They were randomly assigned to the conventional technique group (n = 36), the flexible fiberoptic bronchoscopy group (n = 36), or the Trachway® flexible stylet group (n = 36). The primary endpoint was the time needed for intubation. T1, the time from the tip of the blade passing between the patient’s lips to identification of the vocal cords; and T2, the time from identification of the vocal cords to the bronchial lumen was in the correct position.ResultsT1 had no significant difference between groups, but T2 was significantly shorter in the Trachway® flexible stylet group (p < 0.0001) and longer in the conventional technique group (p < 0.0001).ConclusionsUsing Trachway® flexible stylet for correct placement of double-lumen endobronchial tubes not only significantly shortened the intubation time, but also reduced incidence of carinal injuries. It is an alternative, and a choice with good safety.Trial registrationClinicalTrials.gov Identifier: NCT02364622, 18/02/2015, Retrospectively registered.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Effect of Use of a Bougie vs Endotracheal Tube With Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation

For critically ill adults undergoing emergency tracheal intubation, failure to intubate the trachea on the first attempt occurs in up to 20% of cases and is associated with severe hypoxemia and cardiac arrest. Whether using a tracheal tube introducer ("bougie") increases the likelihood of successful intubation compared with using an endotracheal tube with stylet remains uncertain. To determine the effect of use of a bougie vs an endotracheal tube with stylet on successful intubation on the first attempt. The Bougie or Stylet in Patients Undergoing Intubation Emergently (BOUGIE) trial was a multicenter, randomized clinical trial among 1102 critically ill adults undergoing tracheal intubation in 7 emergency departments and 8 intensive care units in the US between April 29, 2019, and February 14, 2021; the date of final follow-up was March 14, 2021. Patients were randomly assigned to use of a bougie (n = 556) or use of an endotracheal tube with stylet (n = 546). The primary outcome was successful intubation on the first attempt. The secondary outcome was the incidence of severe hypoxemia, defined as a peripheral oxygen saturation less than 80%. Among 1106 patients randomized, 1102 (99.6%) completed the trial and were included in the primary analysis (median age, 58 years; 41.0% women). Successful intubation on the first attempt occurred in 447 patients (80.4%) in the bougie group and 453 patients (83.0%) in the stylet group (absolute risk difference, -2.6 percentage points [95% CI, -7.3 to 2.2]; P = .27). A total of 58 patients (11.0%) in the bougie group experienced severe hypoxemia, compared with 46 patients (8.8%) in the stylet group (absolute risk difference, 2.2 percentage points [95% CI, -1.6 to 6.0]). Esophageal intubation occurred in 4 patients (0.7%) in the bougie group and 5 patients (0.9%) in the stylet group, pneumothorax was present after intubation in 14 patients (2.5%) in the bougie group and 15 patients (2.7%) in the stylet group, and injury to oral, glottic, or thoracic structures occurred in 0 patients in the bougie group and 3 patients (0.5%) in the stylet group. Among critically ill adults undergoing tracheal intubation, use of a bougie did not significantly increase the incidence of successful intubation on the first attempt compared with use of an endotracheal tube with stylet. ClinicalTrials.gov Identifier: NCT03928925.

Modified Gastric Biopsy Forceps as a Flexible Stylet-Assisted Nasogastric Tube Insertion in Anesthetized and Intubated Patients: A Prospective Randomized Controlled Study

Background: Insertion of a nasogastric tube in an anesthetized intubated patient may be difficult. A nasogastric tube is prone to coil and kink during insertion. The authors hypothesized that gastric biopsy forceps could be used as a flexible stylet-assisted nasogastric tube insertion. It can improve the first-attempt success rate over the conventional blind technique during nasogastric tube insertion in the anesthetized intubated patient. Materials and Methods: Eighty adult patients who required intraoperative nasogastric tube insertions were randomized to the gastric biopsy forceps assisted technique (stylet group) or the conventional blind technique (control group) for insertion of a nasogastric tube. The success rates, the duration of insertion, the incidences of coiling and kinking of a nasogastric tube, and the occurrences of complications were recorded. Results: The first-attempt success rate was 92.5% in the stylet group compared with 65% in the control group (p=0.013). The overall success rate was higher in the stylet group (100% versus 85%, p=0.026). The mean time required to insert the nasogastric tube was shorter in the stylet group (24.85±9.62 versus 62.4±59.38 seconds, p=0.002). The incidences of coiling and kinking were lower in the stylet group (7.5% versus 32.5%, p=0.005). The incidence of minor bleeding was lower in the stylet group, but not statistically significant (2.5% versus 17.5%, p=0.057). No other complications were observed in either groups. Conclusion: The gastric biopsy forceps-assisted nasogastric tube insertion resulted in a higher success rate, less time for insertion, and lower incidence of coiling and kinking of a nasogastric tube than the conventional blind technique in anesthetized intubated patients without serious complications. Keywords: Nasogastric tube; Insertion; Stylet; Gastric biopsy forceps; Success rate

Endotracheal Intubation with Laryngeal Mirror in Simulated Difficult Direct Laryngoscopy: Comparison of Gum Elastic Bougie Versus Styleted Endotracheal Tube.

Laryngeal mirror (LM) is an inexpensive, portable, readily available device which can help visualize the vocal cords in difficult airway (DA) situations. We evaluated its use in improving glottic view prior to placing the airway adjuncts in simulated difficult airway.Eighty patients scheduled to undergo elective surgery under general anaesthesia with endotracheal intubation were allocated- Bougie group (Group B) and Stylet group (Group S). Direct laryngoscopy was performed and CL grade III simulated. The glottic view was obtained using laryngeal mirror and Gum Elastic Bougie (GEB)/ Styleted Endotracheal Tube (ETT) inserted under mirror view. Time taken to obtain glottic view in LM and time for successful intubation were noted.Significant improvement in glottic view with LM was observed, with the view improving to Grade I in 76.25% and grade II in 23.75% of patients. Both groups were comparable with respect to number of attempts and success rate (p = 0.55).The success rate was 90% in group B and 95% in group S. Time taken for intubation was less in Group S (52.44 ± 14.23s vs. 62.805 ± 20.74s) [p = 0.01]. Hence, overall stylet proved to be a better adjunct with mirror guided intubation.We recommend stylet assisted rather than GEB assisted ET intubation under LM guidance in emergency scenarios. Also, further controlled trials are recommended to know the exact location of the mirror in relation to bulb of the laryngoscope as well as different angles at which it is placed to improve the view and stabilize the assembly.

The usefulness of a delivery catheter system for right ventricular "true" septal pacing.

Right ventricular (RV) septum is an alternate site for the placement of RV lead tip instead of RV apex. Recent studies have demonstrated that less than half of the RV leads targeted for septal implantation are placed on the RV septum using a conventional stylet system; new guiding catheter systems have become available for RV lead placement. This study aimed to investigate the usefulness of the delivery catheter system in lead placement on the RV septum when compared with the stylet system. We retrospectively evaluated 198 patients who underwent fluoroscopically guided pacemaker implantation with RV leads targeted to be placed in the RV septum and in whom computed tomography was incidentally and subsequently performed. A delivery catheter was used in 16 patients, and a stylet in 182 patients. The primary endpoint of this study was the success rate of RV lead placement on the RV septum. The proportion of RV lead placement on the RV septum was higher in the delivery catheter group than in the stylet group (100% vs. 44%; p < 0.001). In the stylet group, the lead tips were placed at the hinge in 92 cases (51%) and on the free wall in 9 cases (5%). Paced QRS duration was narrower in the delivery catheter group than in the stylet group (128 ± 16 vs. 150 ± 21ms, p < 0.01). The delivery catheter system designated for pacing leads may aid in selecting RV septal sites and achieve good physiologic ventricular activation.

Effect of the use of an endotracheal tube and stylet versus an endotracheal tube alone on first-attempt intubation success: a multicentre, randomised clinical trial in 999 patients.

PurposeThe effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. We hypothesised that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone.MethodsIn this multicentre randomised controlled trial, conducted in 32 intensive care units, we randomly assigned patients to tracheal tube + stylet or tracheal tube alone (i.e. without stylet). The primary outcome was the proportion of patients with first-attempt intubation success. The secondary outcome was the proportion of patients with complications related to tracheal intubation. Serious adverse events, i.e., traumatic injuries related to tracheal intubation, were evaluated.ResultsA total of 999 patients were included in the modified intention-to-treat analysis: 501 (50%) to tracheal tube + stylet and 498 (50%) to tracheal tube alone. First-attempt intubation success occurred in 392 patients (78.2%) in the tracheal tube + stylet group and in 356 (71.5%) in the tracheal tube alone group (absolute risk difference, 6.7; 95%CI 1.4–12.1; relative risk, 1.10; 95%CI 1.02–1.18; P = 0.01). A total of 194 patients (38.7%) in the tracheal tube + stylet group had complications related to tracheal intubation, as compared with 200 patients (40.2%) in the tracheal tube alone group (absolute risk difference, − 1.5; 95%CI − 7.5 to 4.6; relative risk, 0.96; 95%CI 0.83–1.12; P = 0.64). The incidence of serious adverse events was 4.0% and 3.6%, respectively (absolute risk difference, 0.4; 95%CI, − 2.0 to 2.8; relative risk, 1.10; 95%CI 0.59–2.06. P = 0.76).ConclusionsAmong critically ill adults undergoing tracheal intubation, using a stylet improves first-attempt intubation success.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00134-021-06417-y.

Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial

Introduction Airway management is one of key elements of resuscitation. Endotracheal intubation is still considered the gold standard for airway management during resuscitation. Aim The aim of the study was to compare success rates and intubation time of different endotracheal intubation methods during emergency intubation with difficult airways in the conditions of cardiopulmonary resuscitation in a standardized manikin model. Methods The study was designed as a prospective, randomized, cross-over simulation study. It involved 46 paramedics with at least 5 years of experience in Emergency Medical Service. The participants performed endotracheal intubation under difficult airway conditions during continuous chest compression, implemented with the LUCAS3 chest compression system. Three methods of tracheal intubation were applied: (1) standard Macintosh laryngoscope without a bougie stylet; (2) standard laryngoscope and a standard bougie stylet; (3) standard laryngoscope and a new bougie stylet. Results The overall intubation success rate was 100% in the standard bougie and new bougie groups and lower (86.9%) when no bougie stylet was used (P=0.028). The intubation success rate with the 1st attempt equalled 91.3% for the new bougie group, 73.9% for standard bougie, and only 23.9% in the no-bougie group. The median intubation time was shortest in the new bougie group, where it amounted to 29 s (interquartile range [IQR]: 25–38); the time equalled 38s (IQR:31–44.5) in the standard bougie group and 47.5s (IQR:36–58) in the no-bougie group. The ease of use was lowest in the no-bougie group (85, IQR:63–88), average in the standard bougie group (44, IQR:30–51), and highest in the new bougie stylet group (32, IQR:19–41). Conclusion In this manikin-based study, paramedics were able to perform endotracheal intubation with higher efficacy and in a shorter time using the new bougie stylet as compared with the standard bougie stylet.

Postoperative sore throat and subglottic injury after McGrath\xae MAC videolaryngoscopic intubation with versus without a stylet in patients with a high Mallampati score: a randomized controlled trial

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).

The Clarus Video System (Trachway) and direct laryngoscope for endotracheal intubation with cricoid pressure in simulated rapid sequence induction intubation: a prospective randomized controlled trial

BackgroundDuring an emergency endotracheal intubation, rapid sequence induction intubation (RSII) with cricoid pressure (CP) is frequently implemented to prevent aspiration pneumonia. We evaluated the CVS in endotracheal intubation in RSII with CP, in comparison with a direct laryngoscope (DL).MethodsOne hundred fifty patients were randomly assigned to one of three groups: the CVS as a video stylet (CVS-V) group, the CVS as a lightwand (CVS-L) group and DL group. Primary outcomes were to assess the power of the CVS, compared with DL, regarding the first attempt success rate and intubation time in simulated RSII with CP. Secondary outcomes were to examine hemodynamic stress response and the incidence of complications.ResultsThe first attempt success rates within 30 s and within 60 s were higher in CVS-V and DL group than those in CVS-L group (p = 0.006 and 0.037, respectively). The intergroup difference for intubation success rate within 30 s was nonsignificant and almost all the patients were successfully intubated within 60 s (98% for CVS-L and DL group, 96% for CVS-L group). Kaplan-Meier estimator demonstrated the median intubation time was 10.6 s [95% CI, 7.5 to 13.7] in CVS-V group, 14.6 s [95% CI, 11.1 to 18.0] in CVS-L group and 16.5 s [95% CI, 15.7 to 17.3] in DL group (p = 0.023 by the log-rank test). However, the difference was nonsignificant after Sidak’s adjustment. The intergroup differences for hemodynamic stress response, sore throat and mucosa injury incidence were also nonsignificant.ConclusionsThe CVS-D and DL provide a higher first attempt intubation success rate within 30 and 60 s in intubation with CP; the intubation time for the CVS-V was nonsignificantly shorter than that for the other two intubation methods. Almost all the patients can be successfully intubated with any of the three intubation methods within 60 s.Trial registrationClinicalTrials.gov identifier: NCT03841890, registered on February 15, 2019 (retrospectively registered).

Is Stylet Use During Intubation Associated with Post Intubation Complications

Objective: The basic objective is to evaluate the impacts of placing stylet during tracheal intubation on the post-operative pharyngeal pain in anesthetized patients. Methodology: This randomized control trail was conducted in the department of Anesthesia and ICU, Ch. Pervaiz Ellahi Institute of Cardiology and Nishter Hospital Multan from May 2017 to December 2018. All these patients were divided into two groups group S (stylet group) and group C (control group) by lottery method. All the data was entered and analyzed by the computer software SPSS version 23.2. Results: A total number of 100% (n=386) patients were included in this study, both genders. Gender distribution showed that there were more males than females i.e. 56.2% (n=217) and 43.8% (n=169) respectively. The main outcome variables of this study were pharyngeal pain, airway maintenance and sore throat. It was also noted that group (S) showed easy airway maintenance in 95.9% (n=185) patients. It was observed that, in group (S), 63.2% (n=122) patients were complained from sore throat and 67.4% (n=130) were complained about pharyngeal pain. While on the other hand, in group (C), only 8.3% (n=16) patients were complained about sore throat and 11.4% (n=22) were complained about pharyngeal pain Conclusion: Use of stylet during endotracheal intubation decreases the incidences multiple attempts and make the airway maintenance easy for the anesthetist but on the other side it have complications like sore throat and post intubation pharyngeal pain than those patients in which stylet was not usede. Keywords: Pharyngeal pain, Tracheal Intubation, Stylet, Post-operative. DOI : 10.7176/JMPB/53-05 Publication date :March 31 st 2019

Application of second-generation Shikani optical stylet in critically ill patients undergoing cerebral aneurysm embolization.

ObjectiveThis study was performed to compare the clinical value of the second-generation Shikani optical stylet with that of the Macintosh laryngoscope for tracheal intubation of patients undergoing cerebral aneurysm embolization.MethodsThirty-six patients who underwent cerebral aneurysm embolization were included. The intubation time, intubation success rate, blood oxygen saturation, heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured. Adverse reactions during tracheal intubation and the local tissue injury rate were recorded. Comparisons between the groups were performed with one-way analysis of variance.ResultsThe heart rate, SBP, and DBP upon tracheal intubation and at 1 and 3 minutes were significantly higher in the Macintosh laryngoscope group than in the Shikani optical stylet group. The time to completion of tracheal intubation was significantly shorter and the tissue injury rate was significantly lower in the Shikani optimal stylet group than in the Macintosh laryngoscope group.ConclusionsThe second-generation Shikani optical stylet is a simple, safe, and reliable tool for tracheal intubation in critically ill patients undergoing cerebral aneurysm embolization.