A comparative evaluation of Video Stylet and flexible fibre-optic bronchoscope in the performance of intubation in adult patients

Abstract

Background and Aims:Video Stylet (VS) is a new intubating modality that provides real-time video of endotracheal intubation (ETI). This device does not need alignment of the oral, pharyngeal and tracheal axes to view glottis and can be used in patients with limited mouth opening. The aim of this study was to compare flexible fibre-optic (FO) bronchoscope with VS in elective surgical patients in apparently normal airway patients requiring oral ETI.Methods:Sixty patients undergoing elective surgery under general anaesthesia of age group 20–60 years, weight 40–70 kg, American Society of Anesthesiologist 1 and 2 and modified Mallampatti I and II were included in the study. Patients in group FO (n = 30) were intubated by flexible FO bronchoscope, whereas patients in group VS (n = 30) were intubated by VS. Primary outcome measure was time taken for intubation (TTI). Secondary outcome measures were successful intubation, haemodynamic response and post-operative complications if any.Results:Average TTI in cases of FO group was 38.2 s (95% confidence interval [CI] 36–41) and in VS group was 19.7 s (95% CI 19–21; P = 0.0001). Three patients required a second attempt for successful intubation in FO group compared to eight in VS group (P = 0.2), with no failures in any group. Haemodynamic response and complications rate were greater in VS group; however, the differences were not statistically significant.Conclusion:VS takes lesser time to intubate than flexible FO bronchoscope.

Endotracheal intubation in patients undergoing open abdominal surgery in the lateral position: a comparison between the intubating video stylet and fiberoptic intubating bronchoscopy

“…Another study was performed involving 60 patients undergoing elective procedures in the supine position with the normal airway to compare the time required for intubation between the VS and the FO bronchoscope, showing an 18.5 s difference between the groups with a greater delay when using the FO bronchoscope. Moreover, no statistically significant differences were found in hemodynamic response or complications [ 10 ]. A study conducted by Ong et al [ 16 ] was performed to compare the VS and the Macintosh laryngoscope under 4 different conditions, which were normal airway, immobilization of the cervical spine, tongue swelling with cervical spine fixation, and tongue edema.…”

“…Sample size was calculated by comparing the intubation time between using the VS and FO maneuver in the lateral position of open abdominal surgery cases, as previously reported [ 10 ]. The mean time of intubation was approximately 19.7 ± 2.8 s in the VS group and approximately 38.2 ± 6.9 s in the FO maneuver group (Standard deviation was calculated from the given 95% CI).…”

“…It has a red-light source that is located at the far end of the stylet. Therefore, it is considered to be a more affordable choice than the FO bronchoscope in developing countries [ 10 ].…”

Utility of a Modified Oropharyngeal Airway for Performing Tracheal Intubation Using a Fiberoptic Bronchoscope and Video Stylet: A Randomized Crossover Trial Using a Manikin

“…Unlike VS, however, FOB with MA significantly reduced the time to see the glottis and time to complete intubation, as well as the cumulative success rate. In a previous study where a skilled anesthesiologist performed an intubation using FOB in preoperative patients with normal airways, the median time to complete intubation was measured as 38.2 seconds [ 15 ]. In this study, considering that the median time to complete intubation was 46 seconds when using FOB alone and 31 seconds when using FOB with MA, it may be expected that a novice operator could intubate at the level of a skilled anesthesiologist with the assistance of MA.…”

“…A previous clinical study comparing the performance of VS and FOB alone revealed that FOB had a better success rate of intubation (VS vs. FOB and 73.3% vs. 90%), but the use of VS enabled faster completion of intubation (VS, 19.7 (19–21) seconds vs. FOB 38.2 (36–41) seconds) [ 15 ]. In contrast, in this study, compared with FOB alone, VS alone was superior with respect to the success rate of intubation and time to complete intubation.…”