ORAL INTUBATION USING A LIGHTED STYLET VS DIRECT LARYNGOSCOPY IN OLDER CHILDREN WITH CERVICAL IMMOBILIZATION

Objective: To compare the tracheal intubation success rates of blind o ral intubation using a lighted stylet vs standard of direct laryngosco py in anesthetized pediatric patients wearing rigid cervical collars. Methods: Seventy-eight children were randomly assigned to method of in tubation (lighted stylet or direct laryngoscopy) and intubator; five p atients were excluded after randomization. After sedation and paralysi s, the patients were placed in rigid cervical spine collars to simulat e intubating conditions for trauma patients. Three attempts at intubat ion were allowed. An observer recorded the following parameters during the procedure: 1) number of intubation attempts, 2) duration of each intubation attempt, and 3) complications. The intubators had limited p rior experience with the lighted stylet technique. Results: Thirty-thr ee patients were in the lighted stylet group and 40 were in the laryng oscopy group. The patients in the lighted stylet group required more a ttempts prior to successful intubation (2.2 vs 1.5, p < 0.01), and the success rate was higher for the laryngoscopy group (26/33 vs 39/40, p < 0.05). Conclusions: Blind oral intubation using a lighted stylet un der controlled conditions took longer than direct laryngoscopy. Howeve r, among those successful on the first intubation attempt, the times t o intubation were not significantly different between groups (44.5 vs 52.9 sec), The lighted stylet technique is a viable alternative techni que for intubating children who have concurrent cervical spine immobil ization.