title: Intubation without use of stylet for McGrath videolaryngoscopy in patients with expected normal airway: A randomized noninferiority trial.
abstract: BACKGROUND
  During McGrath videolaryngoscope (VL) intubation, a styletted endotracheal tube maintaining an upward distal tip angle is recommended by some manufacturers. However, a styletted endotracheal tube can elicit rare but potentially serious complications. The purpose of this study was to demonstrate that a nonstyletted tube with exaggerated curvature would be noninferior to a styletted tube for orotracheal intubation using McGrath VL in patients with expected normal airway, by comparing the time to intubation and ease of intubation.
  
  
  METHODS
  One hundred forty patients, ages 19 to 70 years (American Society of Anesthesiologists physical status I-II), undergoing tracheal intubation for elective surgery were randomly allocated to the nonstylet group (n = 70) or the stylet group (n = 70). Anesthesia induction consisted of propofol, remifentanil, and rocuronium. The primary outcome was time to intubation assessed by a blind observer. Cormack and Lehane glottic grade, easy of intubation, and intubation difficulty score (IDS) were also assessed.
  
  
  RESULTS
  Median time to intubation [interquartile range] was not different between the nonstylet group and the stylet group (26 [24-32.5] s vs 27 [25-31] s, P = 0.937). There was no significant in median IDS between the nonstylet group and the stylet group (P = 0.695).
  
  
  CONCLUSIONS
  This study shows that a nonstyletted endotracheal tube with exaggerated curvature has a similar performance to a styletted tube with a hockey-stick curvature during intubation using McGrath VL regarding time taken to successful intubation and easiness of intubation.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Kwak
authors.forename: Sook Young
authors.initials: SY
authors.lastname: Lee
authors.forename: Su Youn
authors.initials: SY
authors.lastname: Lee
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Kim
authors.forename: Jong Yeop
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014741:Video Recording