A prospective randomised study of a rigid video‐stylet vs. conventional lightwand intubation in cervical spine‐immobilised patients

Abstract

Compared with a lightwand which is used blind, Optiscope , a rigid video-stylet, can provide direct imaging of airway structures, potentially offering improved conditions in cervical spine-immobilised patients. We randomly assigned 168 patients who required cervical immobilisation during tracheal intubation to use of the Optiscope or the lightwand. The initial intubation success rate (95% CI) was 90 (82-95)% with the Optiscope and 87 (78-93)% with the lightwand (p = 0.626). Median (IQR [range]) intubation time was longer (19 (12-41 [5-195] s vs. 15 (8-29 [3-117] s; p = 0.016), and there were fewer scooping movements (1 (1-2 [0-9]) vs. 2 (1-3 [0-14]); p = 0.002) when using the Optiscope compared with the lightwand. The incidence of postoperative airway complications was similar in the two groups. The devices were equivalent with respect to initial intubation success rate but the Optiscope yielded slightly longer intubating times.

No radiographic index predicts difficult intubation using the Optiscope™ in cervical spine surgery patients: a retrospective study

“…In a previous study, difficult intubation as defined in the present study was observed in 10% of patients who were intubated using the Optiscope™ with cervical spine immobilization [10]. To reproduce the proportion of cases of difficult intubation with the Optiscope™ with a 95% confidence interval (CI) and a margin of error of 0.05, at least 159 patients were required in this study.…”

“…In this study, difficult intubation with the Optiscope™ was defined as an intubation duration of more than 90 s or failed intubation on the first attempt. In a previous study comparing clinical performance between the Optiscope™ and Surch-Lite™ lightwand (Aaron Medical, St. Petersburg, FL, USA), [10] an intubation duration of 90 s corresponded to the 95th percentile. Therefore, we set the cutoff point of difficult intubation with the Optiscope™ as 90 s. This study had several limitations.…”

“…Therefore the Optiscope™ is especially useful in patients with neck motion that must be minimized during intubation. In previous studies comparing the Optiscope™ with other intubation devices, use of the Optiscope™ resulted in less cervical spine motion than was observed with videolaryngoscopes, as well as a shorter intubation time than flexible fiberoptic bronchoscopes, and fewer scooping movements than lightwands [4,9,10].…”

“…Based on the number of intubation attempts and time required for intubation, patients were assigned to either the easy or difficult intubation group. Difficult intubation (the primary outcome measure) was defined as failed intubation or intubation requiring more than 90 s on the first attempt [10].…”

Does glycopyrrolate premedication facilitate tracheal intubation with a rigid video-stylet?

“…[ 3 – 5 ] Moreover, in patients with difficult airways or limited cervical motion, a rigid video-stylet performs better than conventional airway devices. [ 6 – 9 ] However, deterioration of the view might lead to intubation failure, resulting in multiple intubation attempts, a longer intubating time, and desaturation. [ 1 , 5 ] Therefore, unlike the conventional laryngoscope, decreased oral secretion might provide the advantage of better visualization of the rigid video-stylet.…”