A Comparison of Performance of Endotracheal Intubation Using the Levitan FPS Optical Stylet or Lary-Flex Videolaryngoscope in Morbidly Obese Patients

Abstract

Introduction. The use of videolaryngoscopes is recommended for morbidly obese patients. The aim of the study was to evaluate the Levitan FPS optical stylet (Levitan) vs Lafy-Flex videolaryngoscope (Lary-Flex) in a group of MO patients. Methods. Seventy-nine MO (BMI > 40 kg m−2) patients scheduled for bariatric surgery were included in the study and randomly allocated to the Levitan FPS or Lary-Flex group. The primary endpoint was time to intubation and evaluation laryngoscopic of glottic view. Anesthesiologists were asked to evaluate the glottic view first under direct laryngoscopy using the videolaryngoscope as a standard laryngoscope (monitor display was excluded from use) and then using devices. The secondary endpoint was the cardiovascular response to intubation and the participant's evaluation of such devices. Results. The time to intubation was 8.572.66 sec. versus 5.790.2 sec. for Levitan and Lary-Flex, respectively (P < 0.05). In all cases of CL grade >1 under direct laryngoscopy, the study devices improved CL grade to 1. The Levitan FPS produced a greater cardiovascular response than the Lary-Flex videolaryngoscope. Conclusion. The Lary-Flex videolaryngoscope and the Levitan FPS optical stylet improve the laryngeal visualization in morbidly obese patients, allowing for fast endotracheal intubation, but Lary-Flex produces less cardiovascular response to intubation attempt.

A Paradigm Shift of Airway Management: The Role of Video-Assisted Intubating Stylet Technique

“…There are various intubating modalities for obese patients [115][116][117][118][119][120] and VL is superior to conventional DL [121][122][123][124][125][126][127][128][129][130]. VS is useful in morbid patients due to its improved visualization of the larynx and the ease with tube advancement [131,132].…”

Sheet Barrier and Intubating Stylet

“…Among all the intubating tools, it is interesting to note that optical (lighted and video-assisted) stylets are still not prevalent in many countries so far [59]. Such kinds of optical stylets, originally designed by Shikani [33] and later modified by Levitan [60], have been evaluated in several different clinical scenarios [61][62][63][64][65][66]. The advantages of such an airway management modality are as follows: obtaining better patient glottic view with high first-pass success rates, no need to contact any airway soft tissues and therefore causing less stimulation or tissue damages, maintaining a safe distance between the intubator from patient's mouth, high learning curve, etc.…”

Styletubation in Bariatric Surgery: A Case Report

“…Various alternative intubation tools have been reported other than DL and VL [ 35 ]. Those tracheal intubating modalities include rigid Bullard TM laryngoscope, flexible fiberoptic bronchoscope (FOB), optical stylet [ 36 , 37 , 38 , 39 ], or combined FOB with VL [ 40 ]. The video-assisted intubating stylet technique has recently been termed “styletubation”, in contrast to the concept of the conventional laryngoscopy [ 41 ].…”