The StyletScope™ is a better intubation tool than a conventional stylet during simulated cervical spine immobilization

Abstract

Purpose: We compare the StyletScope™ fibreoptic stylet (FOS) and the Satin Slip™ conventional metal stylet (CMS), during simulated difficult airway management with manual-in-line stabilization in terms of ease of intubation and esophageal intubation. Methods: 193 patients (ASA 1-11, 18-80 yr) were studied in a non-crossover, randomized fashion. Manual-in-line stabilization was applied and the best laryngoscopic view obtained. For the CMS, the primed tracheal tube was advanced under direct vision if Cormack-Lehane grade 1/2, placed behind the epiglottis and advanced blindly if grade 3, and intubation was not attempted if grade 4. For the FOS, the primed tracheal tube was advanced under the direct vision if grade 1/2 and under fibreoptic vision if grade 3/4. Results: Intubation was successful more frequently (P = 0.02) and required fewer attempts (P = 0.003) with the FOS than the CMS. Intubation with the FOS was successful more frequently (P = 0.02) and required fewer attempts (P = 0.007) than the CMS if grade 3/4. For both stylets, intubation required fewer attempts (P < 0.007) and was quicker (P ≤ 0.0001) for grade 1/2 than 3/4. Esophageal intubation occurred more frequently with the CMS (14 Vs 0, P = 0.0001). Conclusion: Tracheal intubation is more successful, requires fewer attempts and esophageal intubation is less frequent with the FOS than the CMS during cervical spine immobilization using manual-in-line axial stabilization. The FOS is a more effective intubation instrument compared to the CMS in patients with simulated cervical spine immobilization.