Difficult airway management: comparison of the Bullard laryngoscope with the video-optical intubation stylet

Purpose: To evaluate, whether the video-optical intubation styler (VOIS) wa s more successful for difficult tracheal intubation than the Bullard laryng oscope (BL). Methods: An intubation mannequin head was modified so that, using a Macinto sh blade size 3, only the epiglottis was visible at direct laryngoscopy, re presenting a grade ill laryngoscopic view. Forty anesthesiologists attempte d tracheal intubation using each technique. Tracheal intubation with the Bu llard laryngoscope was performed using the attached non-malleable intubatin g stylet preloaded with an endotracheal tube. The video-optical intubation stylet inserted into an endotracheal tube was used with direct laryngoscopy . During conventional laryngoscopy, the video-view from the stylet tip allo wed the tracheal tube to be guided behind the epiglottis into the trachea. Ten attempts with each technique were performed by each anesthesiologist in randomized order, Intubation time, and failed intubation (> 60 sec / esoph ageal intubation) were recorded. The operators assessed the degree of diffi culty of each method using a Likert-scale. Results: Mean intubation time (19.2 +/- 4.5 sec for the BL and 18.8 +/- 4.6 sec for the VOIS) was almost the identical. The video-optical intubation s tylet was associated with fewer railed intubations (8 vs 41; P < 0.005) and had a lower degree of difficulty (1.7 +/- 0.65 for the VOIS and 2.6 +/- 0. 74 for the BL; P < 0.0001), No correlation was found between the anesthesio logist's experience and mean intubation time, estimated degree of difficult y or number of unsuccessful intubation. Conclusion: The video-optical intubation stylet was a more effective and si mpler intubation device to facilitate difficult tracheal intubation than th e Bullard laryngoscope.