Comparison of Three Tracheal Intubation Techniques in Thyroid Tumor Patients with a Difficult Airway: A Randomized Controlled Trial

Abstract

Objective: To investigate the effectiveness of the Shikani optical stylet (SOS) and GlideScope video laryngoscope (GVL) for tracheal intubation of thyroid tumor patients with a difficult airway. Subjects and Methods: One hundred and twenty thyroid tumor patients with a difficult airway, who were undergoing elective surgery requiring general anesthesia, were enrolled in the study. They were randomly allocated to 3 groups (n = 40 each) who underwent direct laryngoscopy (DL), SOS or GVL. The outcomes recorded were time to intubation, first-attempt success rate, mean artery pressure (MAP), heart rate (HR) and incidence of complications. Results: The mean time to intubation in the SOS group (group S; 42.4 ± 24.1 s) and the GLV group (group G; 29.8 ± 22.3 s) was significantly less than that in the DL group (group D) (68.8 ± 26.6 s). The first-attempt success rate in group S (90.0%) and group G (97.5%) was significantly higher than that in group D (75.0%; all p < 0.05). The HR and MAP at 1 min after intubation were lowest in group S (76.4 ± 9.2 beats/min and 12.9 ± 1.1 kPa), followed by group G (79.9 ± 9.3 beats/min and 13.0 ± 0.9 kPa) and then group D (90.4 ± 8.1 beats/min and 16.6 ± 1.2 kPa). The difference was statistically significant (all p < 0.05). The incidence of lip or mucosal trauma was lowest in group S, followed by group G and then group D. Conclusion: The SOS and the GLV had advantages over the DL in the management of thyroid tumor patients with a difficult airway in terms of a shorter time to intubation, a higher first-attempt success rate and a reduced incidence of complications. Thus, a rational choice of one of these techniques may be better for the perioperative safety of thyroid tumor patients with a difficult airway.

Shikani Optical Stylet versus Macintosh Laryngoscope for Intubation in Patients Undergoing Surgery for Cervical Spondylosis

“…Previous studies showed the lowest incidence of lip and mucosal trauma with SOS compared with MLS and Glidescope. [ 6 14 ] However, in the study, only three patients in MLS group and one in SOS group had evidence of small lacerations on the lip or oral mucosa. None of the four patients required further treatment, and all resolved within 24 h. These results might be related to the Cormack-Lehane classification applied in all patients before undergoing intubation and the extensive experience of the operator.…”

“…(90.0%) and Phua et al . (97.0%),[ 6 15 ] much higher than that for intubation by MLS (84.2%). Previous studies showed the risk of intubation failure at first attempt was approximately 15.0–35.0% with MLS in patients with increased risk for difficult tracheal intubation.…”

“…Liu et al . [ 6 ] also reported that SOS had advantages over MLS in the management of difficult airway. These outcomes suggest that SOS might be a better choice for managing difficult airway in patients with cervical spondylosis.…”

“…According to the success rates in a previous study, a sample size of 135 patients was calculated to have at least 90.0% power to detect a difference between the two groups, estimated with PASS software (version 8.03; NCSS, LLC, Kaysville, UT, USA). [ 6 ]…”

McGRATH MAC videolaryngoscope versus Macintosh laryngoscope for orotracheal intubation in intensive care patients: the randomised multicentre MACMAN trial study protocol

“… 28 29 Studies performed more recently suggested benefits from videolaryngoscopy but either failed to routinely use neuromuscular blockade, 8 29 in contradiction of current guidelines, or included patients with highly specific characteristics. 30 Furthermore, most studies of videolaryngoscopy were performed in the specific setting of difficult intubation 31 32 ( table 1 ).…”