Clinical assessment of a plastic optical fiber stylet for human tracheal intubation

Background: The authors compared the performance of a prototype intubation aid that incorporated plastic illumination and image guides into a stylet w ith fiberoptic bronchoscopy and direct laryngoscopy for tracheal intubation by novice users. Methods: In a randomized, nonblinded design, patients mere assigned to dire ct laryngoscopy, fiberoptic bronchoscopy, or imaging stylet intubation grou ps. The quality of laryngeal view and ease with which it was attained for e ach intubation was graded by the laryngoscopist. Time to intubation was mea sured in 1-min increments. A sore-throat severity grade was obtained after operation. Results: There were no differences in demographic, physical examination, or surgical course characteristics among the groups. The laryngoscope produce d an adequate laryngeal view more easily than did the imaging stylet or bro nchoscope (P = 0.001) but caused the highest incidence of postoperative sor e throat (P < 0.05). Although the time to intubation for direct laryngoscop y was shorter than for imaging stylet, which was shorter than fiberoptic br onchoscopy(P < 0.05), the quality of laryngeal view with the imaging stylet was inferior to both direct laryngoscopy and fiberoptic bronchoscopy techn iques (P < 0.05). Conclusions: Novices using the imaging stylet produce fewer cases of sore t hroat (compared with direct laryngoscopy) and can intubate faster than when using a bronchoscope in anesthetized adult patients. The imaging stylet ma y be a useful aid for tracheal intubation, especially for those unable to m aintain skills with a bronchoscope.