Comparison of different types of stylets with no-stylet technique for intubation with C-MAC D-Blade® videolaryngoscope in simulated difficult airway: A prospective randomized study

Abstract

Objective: The angulated C-MAC D-Blade videolaryngoscope (VL) is designed for difficult intubation and may not be compatible with standard PVC endotracheal tubes (ETTs). This study was planned to compare efficacy of C-MAC, D-Blade VL using ETT with three different stylets versus no-stylet in patients undergoing tracheal intubation with simulated difficult airway. Methods: After obtaining written informed consent and IEC approval, a total of 144 adult patients were allocated to four groups of 36 each using no-stylet or different types of stylets. The four groups were as follows: Group NS: no-stylet; Group CS: C-MAC stylet; Group DS: D-Blade-type stylet; Group HS: hockey-stick shaped stylet. A rigid appropriate-sized Philadelphia cervical collar was placed around the neck to simulate difficult airway, and C-MAC D- Blade VL was used for intubation. The duration of each intubation stage and attempts were evaluated. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM SPSS Corp.; Armonk, NY, USA), and appropriate tests for different variables were applied. Appropriately, Student’s t test, Chi-square test, Mann–Whitney U test, and one-way ANOVA test were applied. Results: Similar Cormack Lehane grade glottic view was observed in all groups. The number of attempts and duration of intubation were significantly greater using NS group than for other groups. Additional laryngeal manipulation was required in all cases in Group NS, compared to one, zero, and two cases in Groups CS, DS, and HS, respectively ( P < .001). Conclusion: Use of Hockey stick shaped stylet, D-Blade-shaped stylet, and C-MAC stylet decreased the total intubation duration in patients with simulated difficult airway.

Airway management in patients with suspected or confirmed cervical spine injury

“…Goel et al studied the use of three different stylet shapes as adjuncts for tracheal intubation using a C-MAC D-Blade videolaryngoscope[55]. Patients who were predicted to be a difficult tracheal intubation and patients with cervical spinal pathologies were not studied.…”