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Comparison of the success with two bending angles for lighted stylet intubation in children: A prospective randomised
Yanjun Zhang1,2, Hao Guo1,3, Zhanfei Hu4
1The First Central Clinical School, Tianjin Medical University, Tianjin, China.
Insights
A 90° bend angle for lighted stylets significantly improved first-attempt success rates for endotracheal intubation in children aged 4-6 years. This angle also reduced esophageal intubation compared to a 70° angle.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Medical Device Technology
Background:
- Successful orotracheal intubation is critical in pediatric anesthesia.
- The bend angle of a lighted stylet is a key factor influencing intubation success.
- Optimizing lighted stylet design can enhance procedural outcomes in children.
Purpose of the Study:
- To compare the efficacy of 90° versus 70° bend angles of a lighted stylet for endotracheal intubation.
- To evaluate the impact of bend angle on first-attempt success and procedural efficiency.
- To assess safety outcomes, including esophageal intubation, in pediatric patients.
Main Methods:
- A randomized controlled trial involving 136 children aged 4-6 years with normal airways.
- Patients were allocated to undergo orotracheal intubation using a lighted stylet with either a 90° or 70° bend angle.
- Primary outcome was first-attempt success rate; secondary outcomes included intubation time and esophageal entry.
Main Results:
- The 90° bend angle group demonstrated a higher first-attempt success rate (92.6%) compared to the 70° group (80.9%).
- Esophageal intubation occurred less frequently in the 90° group (2/73 attempts) versus the 70° group (9/83 attempts).
- Intubation time and lighted stylet search time were significantly shorter with the 90° bend angle.
Conclusions:
- A 90° bend angle for lighted stylets is superior to a 70° angle for endotracheal intubation in 4-6-year-old children with normal airways.
- Utilizing a 90° bend angle enhances first-attempt success and reduces procedural time and esophageal misplacement.
- This finding supports the optimization of lighted stylet bend angles for improved pediatric airway management.
Background And Aim:
The bend angle of a lighted stylet is an important factor for successful orotracheal intubation. The aim of this study was to test the differences in the success of endotracheal intubation using lighted stylet with 70° versus 90° bend angles in children aged 4-6 years with normal airways.
Methods:
A total of 136 children with normal airways required orotracheal intubation were enrolled and were randomly allocated to the 90° or 70° bend angle groups. The first-attempt success rate was assessed as the primary outcome. The intubation time, lighted stylet search time, lighted stylet withdrawal time, hemodynamic responses, and perioperative complications were recorded as secondary outcomes.
Results:
All intubations were completed within three attempts (the 90° group, 63/5/0; the 70° group, 55/11/2). The first-attempt success rate was higher in the 90° group than that in the 70° group (92.6% [63/68 patients] versus 80.9% [55/68 patients], respectively; risk ratio, 1.15; 95% CI, 1.01-1.31; p = .04). Esophageal entry occurred in nine of 83 intubation attempts in the 70° group and two of 73 intubation attempts in the 90° group (risk ratio, 1.09; 95% CI, 1.01-1.19; p = .04). The intubation time and the lighted stylet search time were significantly shorter in the 90° group than that in the 70° group (intubation time: 12.2 ± 2.0 s versus 14.9 ± 2.6 s, respectively; mean difference, 2.65; 95% CI, 1.87-3.43; p < .01; effect size, 1.16; lighted stylet search time: 5.4 ± 1.0 s versus 8.0 ± 1.6 s, respectively; mean difference, 2.66; 95% CI, 2.21-3.12; p < .01; effect size, 1.95).
Conclusions:
Lighted stylet intubation with a 90° bend angle improved the first-attempt success rate and reduced esophageal intubation in children aged 4-6 years with normal airways.
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