The Shikani Seeing Stylet™ for Difficult Intubation in Children: Initial Experience

Abstract

The Shikani Seeing Stylet™ is a recently introduced reusable intubating stylet, produced in adult and paediatric versions. It combines features of a fibreoptic bronchoscope and a lightwand. Inside a malleable stainless steel sheath, the Shikani Seeing Stylet™ has a fibreoptic cable leading to a distal light source and high-resolution lens. In use, the stylet is placed in the lumen of the selected endotracheal tube and the light source enables the stylet to be used as a lightwand, while the fibreoptic capability enables visualization of the laryngeal inlet. It is portable, relatively inexpensive and easy to maintain. This report describes the use of the stylet on eight occasions in seven children, all of whom were assessed preoperatively as being potentially difficult to intubate. Three had been difficult to intubate previously. All were anaesthetized using inhalational anaesthesia. Once an adequate depth of anaesthesia had been achieved, conventional direct laryngoscopy was performed and identified as Grade 3 in six of the patients and Grade 1 in one. Tracheal intubation was then attempted using the Shikani Seeing Stylet™. On six of the eight occasions the attempt was made by different anaesthetists, none of whom had any prior clinical experience with the stylet. There were seven successful intubations and one failure in a patient who could not be intubated by any method. The Shikani Seeing Stylet™ seems a useful device for use in children with difficult airway problems, suspected cervical spine instability or limited mouth-opening.

A comparison of the Seeing Optical Stylet and the gum elastic bougie in simulated difficult tracheal intubation: a manikin study

“…The utility of the Seeing Optical Stylet has been studied in adults who were not predicted to be difficult intubations [12, 13], where initial reports of its performance were encouraging. It has also been studied in children whose tracheas were predicted to be difficult to intubate [14]. We are unaware of any work examining its usefulness in difficult intubation in adults.…”

Use of Shikani Flexible Seeing Stylet for intubation via the Intubating Laryngeal Mask Airway

“…1 A fibrescope is useful in facilitating intubation via the ILMA, but when it is not available, the "Shikani Flexible Seeing Stylet™" (Clarus Medical, Minneapolis, MN, USA; Figure) presents a useful alternative. [2][3][4] We assessed the efficacy of the ILMA and Shikani Flexible Seeing Stylet™ associated technique using an ILMA endotracheal tube, or a standard endotracheal tube.…”

“…1 The Glidescope videolaryngoscope has been shown to be useful in patients with difficult airways. 2 Compared with the Bullard blade, another difficult airway device that has been used to insert DLTs, 3 the Glidescope may also be easier to use 2 and does not need a special guide. 4 Also, DLTs inserted with the Bullard blade may be successfully placed in the desired left main bronchus only 32% of the time.…”

Evaluation of intubating conditions using stylet by conventional through-tube technique and through Murphy′s eye in patients with high Mallampati scores

“…High scores indicate poor visibility of the or pharyngeal structures. [1] We hypothesized that it would be easier to intubate with the use of stylet using Murphy's eye of endotracheal tube than the conventional through tube method of intubation in patients with a high Mallampati score. To examine our hypothesis, we performed a prospective, cohort study comparing a stylet through Murphy's eye with conventional through tube techniques of intubation in patient cohort with high Mallampati scores.…”