title: Shikani optical stylet-guided intubation via the intubating laryngeal airway in patients with scar contracture of the face and neck.
abstract: OBJECTIVE
  To evaluate the feasibility of the Shikani Optical Stylet (SOS)-guided intubation through a new Intubating Laryngeal Airway (ILA) in anticipated difficult airways caused by scar contracture of the face and neck.
  
  
  METHODS
  Thirty-three adult patients with anticipated difficult airways undergoing selective faciocervical scar plastic surgery under general anesthesia were enrolled in this study. After anesthesia induction, a size 2.5, 3.5 or 4.5 ILA was inserted. Following good lung ventilation being verified, the SOS preloaded with an endotracheal tube was inserted via the ILA. Once the clear vocal cords came into view under the SOS, the endotracheal tube was advanced through glottis into the trachea.
  
  
  RESULTS
  The ILA provided an effective airway in all patients. Intubation was successful at the first attempt on 22/33(66.7%) occasions and at the second attempt on 6/33 (18.2%). Intubation failed in 5 (15.1%) patients who suffered from severe limitation of head extension due to scar contracture of the neck. These patients' tracheas were finally intubated using a fibreoptic bronchoscope via the ILA.
  
  
  CONCLUSIONS
  The SOS-guided intubating method via the ILA is a feasible technique in patients with scar contracture of the face and neck. However, in patients with severe limitation of head extension, the use of SOS cannot be recommended. The SOS can be used as an alternative apparatus when the fibreoptic bronchoscope is not available.
authors.affiliation: Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Yang
authors.affiliation: Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China.
authors.forename: Shi-yi
authors.initials: SY
authors.lastname: Tong
authors.affiliation: Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China.
authors.forename: Jin-hua
authors.initials: JH
authors.lastname: Jin
authors.affiliation: Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China.
authors.forename: Geng-zhi
authors.initials: GZ
authors.lastname: Tang
authors.affiliation: Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China.
authors.forename: Jing-hu
authors.initials: JH
authors.lastname: Sui
authors.affiliation: Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China.
authors.forename: Ling-xin
authors.initials: LX
authors.lastname: Wei
authors.affiliation: Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China.
authors.forename: Xiao-ming
authors.initials: XM
authors.lastname: Deng
mesh_terms: D000293:Adolescent; D000328:Adult; D002921:Cicatrix / Q000150:complications*; D003286:Contracture / Q000150:complications*; D005145:Face; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D009333:Neck