Stylet angulation for routine endotracheal intubation with McGrath videolaryngoscope

Abstract

Background: The McGrath videolaryngoscope (VL) provides excellent laryngoscopic views, but directing an endotracheal tube can be difficult, and thus the routine use of a stylet is recommended. The goal of this study is to determine the appropriate angle (60 degrees vs 90 degrees) of the stylet when using the McGrath VL by comparing the time to intubation (TTI). Methods: One hundred and forty patients aged 19 to 70 years (American Society of Anesthesiologists classification I or II) who required tracheal intubation for elective surgery were randomly allocated to 1 of 2 groups, at the 60 degrees angle (n = 70) or the 90 degrees angle (n = 70). Anesthesia was induced with propofol, fentanyl, and rocuronium. The primary outcome was TTI assessed by a blind observer. Glottic grade, use of optimal external laryngeal manipulation, failed intubation at first attempt, ease of intubation, and severity of oropharyngeal bleeding were also recorded. Results: The mean TTI was significantly shorter in the 60 degrees group than in the 90 degrees group (29.3 +/- 6.4 vs 32.5 +/- 9.4 s, P = 0.022). The glottic grade and degree of intubation difficulty were not significantly different between the 2 groups. Conclusions: When intubating the patients with the McGrath videolaryngoscope, the 60 degrees angled stylet allowed for faster orotracheal intubation than did the 90 degrees angled stylet.