Stylet- or forceps-guided tube exchanger to facilitate GlideScope (R) intubation in simulated difficult intubations - a randomised controlled trial

Abstract

The GlideScope (R) videolaryngoscope is widely used in the management of the difficult airway. However, passing the tracheal tube through the vocal cords can be awkward, and the use of a stylet to guide insertion is recommended. This randomised controlled trial evaluated a forceps-guided tube exchanger as an alternative to the stylet to aid intubation with the GlideScope in patients undergoing anaesthesia, with a simulated difficult airway created by the application of a semi-rigid cervical collar. Data were analysed from 178 patients randomly assigned to undergo intubation using either the stylet (n=88) or a forceps-guided tube exchanger (n=90). All intubations were completed successfully, with first attempt rates of 93.2% using the stylet and 94.4% using the exchanger (p=0.597). The mean (SD) intubation time was 67.8 (28.7) s in the stylet group and 66.1 (15.5) s in the forceps-guided tube exchanger group (p=0.11). The frequency of sore throat 1h after extubation was 34.1% in the stylet group and 2.2% in the tube exchanger group (p<0.001); 24h after extubation the corresponding figures were 40.0% and 11.1% (p<0.001). Using a forceps-guided tube exchanger may offer an advantage over a stylet in guiding tracheal intubation when the GlideScope is used.