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 with fiberoptic bronchoscopy and direct laryngoscopy for tracheal intubation by novice users. Methods: In a randomized, nonblinded design, patients mere assigned to direct laryngoscopy, fiberoptic bronchoscopy, or imaging stylet intubation groups. The quality of laryngeal view and ease with which it was attained for each intubation was graded by the laryngoscopist. Time to intubation was measured 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 produced an adequate laryngeal view more easily than did the imaging stylet or bronchoscope (P = 0.001) but caused the highest incidence of postoperative sore throat (P < 0.05). Although the time to intubation for direct laryngoscopy was shorter than for imaging stylet, which was shorter than fiberoptic bronchoscopy(P < 0.05), the quality of laryngeal view with the imaging stylet was inferior to both direct laryngoscopy and fiberoptic bronchoscopy techniques (P < 0.05). Conclusions: Novices using the imaging stylet produce fewer cases of sore throat (compared with direct laryngoscopy) and can intubate faster than when using a bronchoscope in anesthetized adult patients. The imaging stylet may be a useful aid for tracheal intubation, especially for those unable to maintain skills with a bronchoscope.