title: Determination of the optimal stylet strategy for the C-MAC videolaryngoscope.
abstract: The C-MAC videolaryngoscope is a novel intubation device that incorporates a camera system at the end of its blade, thereby facilitating obtaining a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. It retains the traditional Macintosh blade shape and can be used as a direct or indirect laryngoscope. We wished to determine the optimal stylet strategy for use with the C-MAC. Ten anaesthetists were allowed up to three attempts to intubate the trachea in one easy and three progressively more difficult laryngoscopy scenarios in a SimMan manikin with four tracheal tube stylet strategies: no stylet; stylet; directional stylet (Parker Flex-It); and hockey-stick stylet. The use of a stylet conferred no advantage in the easy laryngoscopy scenario. In the difficult scenarios, the directional and hockey-stick stylets performed best. In the most difficult scenario, the median (IQR [range]) duration of the successful intubation attempt was lowest with the hockey-stick stylet; 18 s (15-22 [12-43]) s, highest with the unstyletted tracheal tube; 60 s (60-60 [60, 60]) s and styletted tracheal tube 60 s (29-60 [18-60]) s, and intermediate with the directional stylet 21 s (15-60 [8-60]) s. The use of a stylet alone does not confer benefit in the setting of easy laryngoscopy. However, in more difficult laryngoscopy scenarios, the C-MAC videolaryngoscope performs best when used with a stylet that angulates the distal tracheal tube. The hockey-stick stylet configuration performed best in the scenarios tested.
authors.affiliation: Department of Anaesthesia, Galway University Hospitals, National University of Ireland, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: McElwain
authors.forename: M A
authors.initials: MA
authors.lastname: Malik
authors.forename: B H
authors.initials: BH
authors.lastname: Harte
authors.forename: N H
authors.initials: NH
authors.lastname: Flynn
authors.forename: J G
authors.initials: JG
authors.lastname: Laffey
mesh_terms: D002983:Clinical Competence; D018592:Cross-Over Studies; D004487:Edema / Q000150:complications; D004867:Equipment Design; D006801:Humans; D007103:Immobilization; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods; D020704:Laryngoscopes; D008348:Manikins; D009989:Orthotic Devices; D014060:Tongue Diseases / Q000150:complications; D014741:Video Recording / Q000295:instrumentation*