Styletubation in Bariatric Surgery: A Case Report

Abstract

Direct laryngoscopes and videolaryngoscopes are the dominant endotracheal intubation tools. The styletubation technique (using a video-assisted intubating stylet) has shown its advantages in terms of short intubation time, high success rate, less required stimulation, and operator satisfaction. The learning curve can be steep but is easily overcome if technical pitfalls are avoided. Conditions that make styletubation challenging include secretions/blood, short/stiff neck, restricted mouth opening and cervical spine mobility, anatomical abnormalities over head and neck regions, obesity, etc. In this clinical report, we present the effectiveness and efficiency of the routine use of the styletubation for tracheal intubation in a super-super-obese patient (BMI 103 kg/m2) undergoing bariatric surgery with laparoscopic sleeve gastrectomy.

Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

“…The time to intubation was 18 s with first-pass success. The result is similar to our previous report regarding the role of styletubation in obese population [43,47]. It is worthy to note that ramp positioning with sniffing position and keeping patient's neck until horizontal alignment between the sternal notch space and the external auditory meatus is helpful for laryngoscopy in obese patients [133,134].…”

“…Other intubating tools, e.g., rigid Bonfils fiberscope, when compared to VL, can be successfully used for awake intubation in morbidly obese patients when difficult airways are anticipated [130]. In obese patients, the use of the Video Intubation Unit and VS significantly improves the visualization of the larynx, thereby improving the intubation conditions [47,131,132]. Here, we demonstrate such role of styletubation in an obese patient (Figure 11).…”

“…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]. In the following text, we will present several related issues to the styletubation technique.…”

“…), 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].…”

Super super obesity with a BMI of 98 kg/m2: a case report

“…Our patient was intubated using the conventional DL and a troop intubation pillow by a well-trained Anesthesiologist which was done smoothly without the need of video assisted intubation. Video laryngoscope (VD) was used in a case of an LSG in a patient with a BMI of 103 kg/m 2 which was reported to be an effective and efficient way of intubation for obese patients [ 6 ]. No further peri-anesthesia measurements were specifically undertaken in comparison to patients with lower BMI.…”