A pilot study comparing three bend angles for lighted stylet intubation

Dongwook Won, Jung-Man Lee, Jiwon Lee, Jin-Young Hwang, Tae Kyong Kim, Jee-Eun Chang, Hyerim Kim, Seoyoung Ma, Seong-Won Min, Dongwook Won, Jung-Man Lee, Jiwon Lee, Jin-Young Hwang, Tae Kyong Kim, Jee-Eun Chang, Hyerim Kim, Seoyoung Ma, Seong-Won Min

Abstract

Background: For successful lighted stylet intubation, bending the lighted stylet with an appropriate angle is a prerequisite. The purpose of this study was to compare three different bend angles of 70, 80, and 90 degrees for lighted stylet intubation.

Methods: The patient trachea was intubated with a lighted stylet bent at 70, 80, or 90 degrees according to the randomly allocated groups (group I, II, and III, respectively). A lighted stylet combined with a tracheal tube was prepared with a bend angle of 70, 80, or 90 degrees according to the assigned group. We checked the success rate at the first attempt and overall success rate for the two attempts. Additionally, we measured search time, which was time from insertion of the bent union into the patient mouth to the start of advancing the tracheal tube while separating it from the lighted stylet, and evaluated postoperative sore throat (POST) at 2, 4, and 24 h after the recovery from anesthesia.

Results: There was no statistically significant difference between group I, II, and III for success rate at first attempt (73.9 %, 88.2 %, and 94.7 %, respectively, p = 0.178), even though there was a trend of increasing success rate with increasing bend angles. For overall success rate, there was similar result to that in the first attempt between the groups I, II, and III (82.6 %, 94.1 %, and 100 %, respectively, p = 0.141). However, search time took significantly longer in group I than groups II and III (p < 0.001). When group II and III were compared for POST with numeric rating scale (0-10), it was significantly lower in group II than III at 2, 4 h after the recovery (0.5 vs. 2.3, p = 0.016, and 0.4 vs. 1.8, p = 0.011, respectively).

Conclusions: The bend angle of the lighted stylet affected the time required for tracheal intubation and POST in our study. 80 and 90 degrees as a bend angle seem to be acceptable for clinicians in regard to success rate of lighted stylet intubation. Considering the success rate of lighted stylet intubation and POST, the bend angle of 80 degrees might be better than 70 and 90 degrees.

Trial registration: ClinicalTrials.gov Identifier NCT03693235 , registered on 30 September 2018.

Keywords: Lighted stylet; Postoperative sore throat; Tracheal intubation.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Schematic diagram for preparation of the lighted stylet combined with the tracheal tube. The asterisk (*) indicates 'bend length' which is the length of the distal arm after bending the union. The cross (†) represents 'bend angle' which is the angle between the distal arm and proximal arm after bending the union
Fig. 2
Fig. 2
Pre-made samples of lighted stylet and tracheal tube (LS-TT) with an angle of 70, 80, or 90 degrees. a 70 degree, b 80 degree, c 90 degree
Fig. 3
Fig. 3
CONSORT flow diagram

References

    1. Hung OR, Pytka S, Morris I, Murphy M, Stewart RD. Lightwand intubation: II–Clinical trial of a new lightwand for tracheal intubation in patients with difficult airways. Can J Anaesth. 1995;42(9):826–30. doi: 10.1007/BF03011187.
    1. Davis L, Cook-Sather SD, Schreiner MS. Lighted stylet tracheal intubation: a review. Anesth Analg. 2000;90(3):745–56. doi: 10.1097/00000539-200003000-00044.
    1. Djordjevic D. Trachlight -- learning tips. Can J Anaesth. 1999;46(6):615. doi: 10.1007/BF03013557.
    1. Chen TH, Tsai SK, Lin CJ, Lu CW, Tsai TP, Sun WZ. Does the suggested lightwand bent length fit every patient? The relation between bent length and patient’s thyroid prominence-to-mandibular angle distance. Anesthesiology. 2003;98(5):1070–6. doi: 10.1097/00000542-200305000-00008.
    1. Chen J, Luo W, Wang E, Lu K. Optimal bent length of lightwand for intubation in adults: a randomized, prospective, comparative study. J Int Med Res. 2012;40(4):1519–31. doi: 10.1177/147323001204000432.
    1. Hung OR, Stewart RD. Lightwand intubation: I–a new lightwand device. Can J Anaesth. 1995;42(9):820–5. doi: 10.1007/BF03011186.
    1. Ellis DG, Jakymec A, Kaplan RM, Stewart RD, Freeman JA, Bleyaert A, Berkebile PE. Guided orotracheal intubation in the operating room using a lighted stylet: a comparison with direct laryngoscopic technique. Anesthesiology. 1986;64(6):823–6. doi: 10.1097/00000542-198606000-00029.
    1. Hung OR, Pytka S, Morris I, Murphy M, Launcelott G, Stevens S, MacKay W, Stewart RD. Clinical trial of a new lightwand device (Trachlight) to intubate the trachea. Anesthesiology. 1995;83(3):509–14. doi: 10.1097/00000542-199509000-00009.
    1. Adnet F, Borron SW, Dumas JL, Lapostolle F, Cupa M, Lapandry C. Study of the “sniffing position” by magnetic resonance imaging. Anesthesiology. 2001;94(1):83–6. doi: 10.1097/00000542-200101000-00017.
    1. Biro P, Seifert B, Pasch T. Complaints of sore throat after tracheal intubation: a prospective evaluation. Eur J Anaesthesiol. 2005;22(4):307–11. doi: 10.1017/S0265021505000529.
    1. Julious S. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceut Statist. 2005;4:287–91. doi: 10.1002/pst.185.
    1. Nishiyama T, Matsukawa T, Hanaoka K. Optimal length and angle of a new lightwand device (Trachlight) J Clin Anesth. 1999;11(4):332–5. doi: 10.1016/S0952-8180(99)00056-2.
    1. Scuderi PE. Postoperative sore throat: more answers than questions. Anesth Analg. 2010;111(4):831–2. doi: 10.1213/ANE.0b013e3181ee85c7.
    1. Aoyama K, Takenaka I, Nagaoka E, Kadoya T, Sata T, Shigematsu A. Potential damage to the larynx associated with light-guided intubation: a case and series of fiberoptic examinations. Anesthesiology. 2001;94(1):165–7. doi: 10.1097/00000542-200101000-00030.
    1. Greenland KB, Edwards MJ, Hutton NJ, Challis VJ, Irwin MG, Sleigh JW. Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible clinical applications. Br J Anaesth. 2010;105(5):683–90. doi: 10.1093/bja/aeq239.
    1. Chou HC, Wu TL. Rethinking the three axes alignment theory for direct laryngoscopy. Acta Anaesthesiol Scand. 2001;45(2):261–2.
    1. Debo RF, Colonna D, Dewerd G, Gonzalez C. Cricoarytenoid subluxation: complication of blind intubation with a lighted stylet. Ear Nose Throat J. 1989;68(7):517–20.
    1. El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia. 2016;71(6):706–17. doi: 10.1111/anae.13438.
    1. Greenland KB. A proposed model for direct laryngoscopy and tracheal intubation. Anaesthesia. 2008;63(2):156–61. doi: 10.1111/j.1365-2044.2007.05326.x.

Source: PubMed

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