Comparison between GlideRite® rigid stylet and Parker Flex-It™ stylet to facilitate GlideScope intubation in simulated difficult intubation: a randomized controlled study

Background: The GlideScope® videolaryngoscope (GVL) is widely used in patients with difficult airways and provides a good glottic view. However, the acute angle of the blade can make insertion and advancement of an endotracheal tube (ETT) more difficult than direct laryngoscopy, and the use of a stylet is recommended. This randomized controlled trial compared Parker Flex-It™ stylet (PFS) with GlideRite® rigid stylet (GRS) to facilitate intubation with the GVL in simulated difficult intubations. Methods: Fifty-four patients were randomly allocated to undergo GVL intubation using either GRS (GRS group) or PFS (PFS group). The total intubation time (TIT), 100-mm visual analog scale (VAS) for ease of intubation, success rate at the first attempt, use of laryngeal manipulation, tube advancement rate by assistant, and complications were recorded. Results: There was no significant difference between the GRS and PFS groups regarding TIT (50.3 ± 12.0 s in the GRS group and 57.8 ± 18.8 s in the PFS group, P = 0.108). However, intubation was more difficult in the PFS group than in the GRS group according to VAS score (P = 0.011). Cases in which the ETT was advanced from the stylet by an assistant, were more frequent in the GRS group than in the PFS group (P = 0.002). The overall incidence of possible complications was not significantly different. Conclusions: In patients with a simulated difficult airway, there was no difference in TIT using either the PFS or GRS. However, endotracheal intubation with PFS is more difficult to perform than GRS.

Comparison of three types of intubation stylets for tracheal intubation with a McGrath MAC® video laryngoscope by novice intubators in simulated cervical immobilisation: A randomised crossover manikin study

Introduction: Tracheal intubation using video laryngoscopes has been a better approach for trauma patients requiring cervical immobilisation. The aim of this study was to compare the time to successful intubation by novice intubators using three types of intubation stylets with the new McGrath MAC video laryngoscope in a manikin model. Methods: This was a randomised crossover manikin study. The participants performed tracheal intubations using three intubation stylets (arcuate shape malleable stylet, McGrath MAC-shaped malleable stylet and McGrath MAC-shaped rigid stylet) in a difficult airway model with cervical immobilisation. The order of the stylets was randomised. The primary outcome was the time to successful intubation. The secondary outcomes were the overall success rates, incidence of dental trauma and ease of intubation. All intubation attempts were assessed by trained assistants. The data were analysed using a multilevel model followed by Tukey’s post hoc test. Results: A total of 68 nurses participated in this study. The time to successful intubation of the McGrath MAC-shaped malleable stylet was significantly shorter than that of the arcuate shape malleable stylet (24.5 (18.0–51.0) s vs 31.5 (21.0–89.0) s, p = 0.005). The overall success rate of the McGrath MAC-shaped malleable stylet was also higher than that of the arcuate shape malleable stylet ( p = 0.047). The participants indicated that intubation was easier using the McGrath MAC-shaped malleable stylet compared with the other stylets. Conclusion: The McGrath MAC-shaped malleable stylet, when used by novice intubators, may be an optimal stylet shape for tracheal intubation using the McGrath MAC in cervical immobilisation.

Palatopharyngeal wall Perforation during Glidescope® Intubation

We report a case of palatopharyngeal wall perforation during intubation with a GlideScope® laryngoscope. The likely mechanism was advancing and rotating the endotracheal tube against a taut palatopharyngeal fold. This was missed during the initial laryngoscopy, because there is a potential blind-spot in the oropharynx when attention is focused on the GlideScope® monitor. Fortunately, there were no sequelae other than minor bleeding and a mild sore throat and no surgical intervention was necessary. The use of unnecessary force during the endotracheal tube insertion, the use of too large a laryngoscope blade and the use of a rigid stylet could possibly also have been contributory factors to this complication.