Stylet angulation of 70 degrees reduces the time to intubation with the GlideScope®: A prospective randomised trial

Yong-Cheol Lee, Jiwon Lee, Je-Do Son, Jae-Yoon Lee, Hyun-Chang Kim, Yong-Cheol Lee, Jiwon Lee, Je-Do Son, Jae-Yoon Lee, Hyun-Chang Kim

Abstract

Objective The GlideScope® videolaryngoscope provides a good view of the glottis. However, directing and inserting an endotracheal tube is sometimes difficult during intubation with the GlideScope®. In this study, we compared two GlideScope® stylet angulations (90° vs. 70°) in terms of the time to intubation. Methods In total, 162 patients scheduled for elective surgery under general anaesthesia were randomly assigned to one of two groups. In the 90 group ( n = 79), a 90° stylet was used. In the 70 group ( n = 78), a 70° stylet was used. The time to intubation was recorded. The number of intubation attempts was assessed. Results The time to intubation was significantly shorter in the 70 than 90 group [26.0 (23.0-32.0) vs. 37.0 (30.0-43.0) s, respectively]. The first-time intubation success rate was significantly higher and the number of failed intubations was significantly lower in the 70 than 90 group (100% vs. 87% and 0% vs. 6%, respectively). Conclusions This investigation suggests that a 70° angle stylet is superior to a 90° angle stylet for GlideScope® intubation. Trial Registration Clinicaltrials.gov Identifier: NCT02547064.

Keywords: Laryngoscopic view; difficult airway algorithm; grading; laryngoscopy complications; stylet angulation; time to intubation.

Figures

Figure 1.
Figure 1.
(a) The two endotracheal tubes (ETTs) with stylets are shown: 70° (top) and 90° (bottom). The ETT with the 70° angle stylet was prepared as follows: the ETT was bent by 60° at a point 10 cm from its distal end and by an additional 10° at a point 6 cm from its distal end to facilitate directing the ETT distal tip toward the vocal cords. The proximal portion of the ETT was formed in the shape of the GlideScope® blade until the point of the handle was reached. The ETT with the 90° angle stylet was bent at a point 8 cm from its distal end. (b) The ETT with the 70° angle stylet and an illustration of the GlideScope® blade.
Figure 2.
Figure 2.
CONSORT diagram showing the flow of patients through the phases of the trial.
Figure 3.
Figure 3.
Haemodynamic variables before and 2 min after GlideScope® intubation.
Figure 4.
Figure 4.
Kaplan–Meier plot of time to intubation for patients using the 70° or 90° stylet. The log-rank test showed a significant difference between the groups (P < 0.001).

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