Appropriate shape of a stylet for tracheal intubation using the McGrath® MAC videolaryngoscope in neonates: a randomized crossover simulation study

TL;DR

This study compares different stylet shapes for tracheal intubation in neonates using a videolaryngoscope to determine which shape is most effective.

Contribution

The study identifies that specific stylet shapes can impact intubation time in neonates during simulated procedures.

Findings

The J-shaped and hockey stick-shaped stylets increased intubation time compared to no stylet.

C-shaped and double C-shaped stylets did not significantly affect intubation time compared to no stylet.

Abstract

Guidelines on airway management in neonates and infants recommend using a stylet when a videolaryngoscope is used, but it is not clear if the use of a stylet facilitates tracheal intubation and which shape of the stylet is suitable in neonates.

As a preliminary simulation study of a randomized controlled cross-over design, 25 anesthesiologists (3 specialists, 11 senior residents, and 11 junior residents) used a McGrath® MAC videolaryngoscope (Covidien, Medtronic, Tokyo, Japan) blade 1 for tracheal intubation (of a 3.5-mm ID Shiley™ tube with a cuff), with one of four differently shaped stylets (C-shaped, J-shaped, hockey stick-shaped and double C-shaped) or without a stylet in a manikin of a neonate, and compared intubation times.

Compared with intubation time without the use of a stylet, intubation time was significantly longer with the use of the J-shaped stylet (P = 0.007; median (95% CI) difference: 2 (1 to 2) s) or with the hockey stick-shaped stylet (P = 0.0002; median (95% CI) difference: 9 (9 to 10) s). In contrast, intubation time was similar between no stylet and the C-shaped stylet (P = 0.90; median (95% CI) difference: 0 (0 to 0) s) or between no stylet and the double C-shaped style (P = 0.60; median (95% CI) difference: 0 (0 to 0) s).

In conclusion, while time to tracheal intubation would be similar with and without the use of a stylet, the shape of the stylet would affect intubation time in neonates.

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