Comparison of Directable Stylet with Stylet Angulated 75° for Routine Orotracheal Intubation with Conventional...

A 75° angulated stylet is commonly recommended for videolaryngoscopy, but it increases resistance during endotracheal tube (ETT) advancement and stylet withdrawal. A directable stylet allows dynamic adjustment of the ETT tip during intubation and may facilitate smoother and faster tube placement. Evidence comparing the efficacy of these two stylet techniques during C-MAC videolaryngoscopy remains limited.

A prospective, randomized study was conducted in 76 adult patients scheduled for elective surgical procedures requiring orotracheal intubation at a tertiary care teaching hospital. Patients were randomly allocated into two groups based on the stylet used (directable stylet or 75° angulated stylet), each with 38 cases. All intubations were performed using the C-MAC videolaryngoscope by experienced anesthesiologists. The first-attempt success rate, intubation time and complications were compared between the two stylets.

First-attempt success rates were 100% in both groups. The directable stylet group demonstrated a significantly shorter mean time to intubation compared to the 75° stylet group (38.95 ± 20.01 versus 48.68 ± 17.72 s, P < 0.001). Although both groups achieved comparable glottic views with the C-MAC videolaryngoscope, the difficulty encountered during advancement of the ETT did not differ between the groups (P > 0.05); the stylet was reported as easy to remove more often in the directable than in the 75° stylet group (100% versus 65.8%, P < 0.001). Airway-related complications were infrequent and did not differ significantly between the groups, although the study was not powered to detect a difference in this outcome.

The directable stylet was associated with a shorter intubation time and more frequently reported ease of stylet removal, with no difference in first-attempt success or in airway complications. As both groups achieved 100% first-attempt success and the sample size was calculated for intubation time alone, the clinical significance of this time difference remains uncertain. Adequately powered studies involving difficult airway scenarios are required to validate these findings.