No abstract

Fibreoptic and video technologies are widely used for airway management. Fibreoptics have been used in most airway intubation devices, including rigid laryngoscopes and in the tracheal tube wall itself. 10 22 Optical stylets, which incorporate¯exible ®breoptic imaging elements in an intubation stylet, have now also become available.More than 10 new optical stylet devices have been introduced since 1995, which shows that combining viewing capability with the familiar handling of a stylet is an appealing concept (Table 1). But are these useful tools? Are their clinical performances similar or is one best? We survey the evolution of optical stylets, describe their properties, summarize their clinical performance and describe an ideal system. HistoryAlmost 35 years ago, Murphy reported successful nasal intubation using a¯exible choledochoscope placed through a tracheal tube. 19 Flexible ®breoptic technology was then used to assist with intubation. The Flexible Fiberoptic Laryngoscope was a short¯exible bronchoscope with a pistol-grip handle, angulation control lever and eyepiece (Fig. 1). The use of this device was reported in 1972 32 and additional reports soon followed. 3 9 23 33 40 Over the years other similar devices were developedÐthe Port-O-Scope (Mercury Medical, Clearwater, FL, USA) and the Rapiscope (Cook Critical Care, Bloomington, IN, USA)Ð but unlike the¯exible bronchoscope, they never found widespread use. 8 28 Katz and Berci 4 13 coined the term`optical stylet' in 1979 to describe a straight rigid endoscope used as a tracheal tube stylet during intubation (Fig. 2). Although used extensively for teaching purposes, its rigid straight design limited its use in dif®cult airway management. Bon®ls modi®ed this by adding a ®xed curve to the distal end (Fig. 3). The Bon®ls Retromolar Intubation Fiberscope (Karl-Storz, Culver City, CA, USA) was used for dif®cult intubations from a retromolar approach. 7 The earliest intubation aid with ®breoptic technology in a semi-malleable and formable stylet was the Fiberoptic Stylet Laryngoscope, introduced in the mid-1970s (Fig. 4). 20 This con®guration remains popular. Commercial failuresDespite their popularity, the ®rst optical stylets developed are no longer commercially available. More recent devices with a Schroeder stylet design 18 36 (Aeroview, Imagyn,