title: Atraumatic intubation: experience using a 5.0 endotracheal tube without a stylet for laryngeal surgery.
abstract: OBJECTIVE
  Vocal fold injury is a well-know complication of intubation, with rates reported as high as 69%. Laryngology textbooks recommend the use of a small endotracheal tube (ETT) to help avoid these complications and optimize visualization. Case reports have suggested that the rigid stylet can lead to laryngeal injury. Given the additional risks, intubation without the stylet is our preferred practice. There is limited documentation in the literature regarding this viewpoint. Our study investigated the feasibility of and potential barriers to intubation using 5.0 ETT without a stylet.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Consecutive adult patients undergoing laryngeal surgery were recruited for intubation with a 5.0 ETT without a stylet. Demographic data, specialty and training level of the intubator, and factors that would predict a difficult intubation were recorded. Descriptive statistical analysis was performed.
  
  
  RESULTS
  Findings of the participants (n = 67) included average American Society of Anesthesiologists (ASA) physical status classification (2.2), average Mallampati score (1.7), average Cormack-Lehane grade (1.5), and average body mass index (28.0). Five patients (7.4%) required intubation using a stylet, and one of these five participants was intubated initially with a stylet. Of these five participants, 80% required use of a GlideScope (P < .001), and they had significantly higher ASA classification (P = .047) and number of intubation attempts (P = .042). One patient sustained an oropharyngeal injury during intubation with a stylet. No participants had laryngeal injury.
  
  
  CONCLUSIONS
  Most patients can be intubated successfully using a 5.0 ETT without a stylet. There were no cases of laryngeal trauma with this technique.
  
  
  METHODS
  2b.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Jaime E
authors.initials: JE
authors.lastname: Moore
authors.forename: Amanda
authors.initials: A
authors.lastname: Hu
authors.forename: Amy
authors.initials: A
authors.lastname: Rutt
authors.forename: Parmis
authors.initials: P
authors.lastname: Green
authors.forename: Mary
authors.initials: M
authors.lastname: Hawkshaw
authors.forename: Robert T
authors.initials: RT
authors.lastname: Sataloff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D007818:Laryngeal Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014827:Vocal Cords / Q000293:injuries
keywords: Stylet; dysphonia; laryngeal surgery; laryngeal trauma; traumatic intubation; vocal fold injury