An Approach to Improve the Effectiveness of the Video-Assisted Intubating Stylet Technique for Tracheal Intubation: A Case Series Report

Abstract

Direct laryngoscopy and videolaryngoscopy are currently the dominant tools for endotracheal intubation. However, the video-assisted intubating stylet, a type of videolaryngoscopy, has been shown to offer some advantages over these tools, such as rapid intubation time, high first-attempt success rates, less airway stimulation, and high subjective satisfaction. On the other hand, this optical intubating technique also has some technical limitations that need to be addressed, including camera lens fogging, airway path disorientation, and obscured visibility due to secretions. In this clinical report, we describe an approach that improves the visibility of the glottis by introducing a suctioning catheter into the nasopharyngeal airway to enhance the efficiency and accuracy of using the intubating stylet technique for tracheal intubation.

Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

“…During the past two decades since the Shikani Seeing Stylet™ and its technique had been introduced, a gradual increase in adopting this intubating tool has been observed in literature. The clinical application of video-assisted intubating stylet (VS) and Shikani technique (Figure 2) covered a broad spectrum of airway management scenarios, such as pediatric difficult airways, limited cervical spine mobility, limited mouth-opening (but still enough to accommodate an ET tube), headneck lesions, obesity, etc [37][38][39][40][41][42][43][44]. Because operational technique of such Shikani technique with VS is sharply different form that of conventional laryngoscopy technique, we therefore coined the term "styletubation" to reflect its uniqueness and advantages (Figure 2) [45][46][47][48].…”

“…), styletubation technique is the common and routine technique universally adopted for tracheal intubation in HTZGH (Table 1). Styletubation technique has therefore been applied for both normal and difficult airways [37][38][39][40][41][42][43][44][45][46][47][48]155,156]. Universal application of VL for routine tracheal intubationhas recently been advocated [25,26,[186][187][188][189][190], although some pros-cons arguments still existed [191].…”

Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

“…The clinical application of a video-assisted intubating stylet (VS) and the Shikani technique (Figure 2) covered a broad spectrum of airway management scenarios, such as pediatric difficult airways, limited cervical spine mobility, limited mouth opening (but still enough to accommodate an ET tube), head-neck lesions, obesity, etc. [37][38][39][40][41][42][43][44].…”

“…The clinical application of a video-assisted intubating stylet (VS) and the Shikani technique (Figure 2) covered a broad spectrum of airway management scenarios, such as pediatric difficult airways, limited cervical spine mobility, limited mouth opening (but still enough to accommodate an ET tube), head-neck lesions, obesity, etc. [37][38][39][40][41][42][43][44]. Because an operational technique like the Shikani technique with a VS is sharply different form that of a conventional laryngoscopy technique, we, therefore, coined the term "styletubation" to reflect its uniqueness and advantages (Figure 2) [45][46][47][48].…”

“…), the styletubation technique is the common and routine technique universally adopted for tracheal intubation in HTZGH (Table 1). The styletubation technique has, therefore, been applied for both normal and difficult airways [37][38][39][40][41][42][43][44][45][46][47][48]155,156]. In Table 2, comparisons of device features and clinical performance between the VL and styletubation are presented.…”