Comparison of the Shikani Optical Stylet and Macintosh Laryngoscope for Orotracheal Intubation with Topical Anesthesia in Critically Ill Patients
Clinical Medicine Research
Volume 7, Issue 4, July 2018, Pages: 84-91
Received: Jun. 17, 2018; Accepted: Aug. 29, 2018; Published: Sep. 28, 2018
Views 1029      Downloads 70
Zhipeng Li, Department of Anesthesiology, Chancheng Center Hospital, Foshan, PR China
Meirong Wang, Department of Anesthesiology, Chancheng Center Hospital, Foshan, PR China
Qiong Wang, Department of Anesthesiology, Chancheng Center Hospital, Foshan, PR China
Chuiliang Liu, Department of Anesthesiology, Chancheng Center Hospital, Foshan, PR China
Article Tools
Follow on us
Background: Emergency airway management outside operating room (OR) is associated with a higher incidence of difficult intubations. The Shikani optical stylet (SOS) has been shown to improve first-attempt success rates compared with the classic Macintosh laryngoscope (ML) in patients with difficult airway inside the operating room (OR). Objective: In this randomized controlled clinical trial, the effectiveness of using a SOS as the primary intubation device was assessed during urgent endotracheal intubations (UEI) in conscious, critically ill patients outside the OR. Method: Sixty conscious critically ill patients from May 2018 to March 2018 were randomly assigned to undergoing intubation guided by the SOS (group S, n = 30) or the Macintosh laryngoscope (group M, n = 30) in ChanCheng Center Hospital,. After application of airway topical anesthesia and intravenous sedatives, endotracheal intubations were performed. The primary measured outcome was first-attempt intubation success rate. Secondary outcomes included ultimate success, the number of attempts, the duration of intubation, and the adverse effects or complications of intubation. Result: The rate of successful intubation at the first-attempt was superior with the SOS as compared with the ML (93.3% vs 63.3%, P = 0.005), the average number of attempts required for successful tracheal intubation (1.0 ± 0.3 vs 1.5 ± 0.8, P = 0.004), the duration of intubation (18.8 ± 11.9 vs 26.8 ± 15.6, P = 0.028), and the incidences of hemorrhage in the oropharyngeal mucosa (0 vs 28.6%, P = 0.006) were all improved significantly with use of the SOS compared with the ML. Conclusion: This study suggested SOS could be used as the effective device when UEIs are performed by experienced operators in conscious, critically ill patients outside the operating room.
Airway Management, Intubation, Intratracheal, Critical Illness, Laryngoscope, Optical Stylet
To cite this article
Zhipeng Li, Meirong Wang, Qiong Wang, Chuiliang Liu, Comparison of the Shikani Optical Stylet and Macintosh Laryngoscope for Orotracheal Intubation with Topical Anesthesia in Critically Ill Patients, Clinical Medicine Research. Vol. 7, No. 4, 2018, pp. 84-91. doi: 10.11648/j.cmr.20180704.11
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Higgs A, Cook T M, Mcgrath B A. Airway management in the critically ill: the same, but different. British Journal of Anaesthesia, 117 (suppl_1):i5–i9, 2016.
Nolan JP, Soar J. Airway techniques and ventilation strategies. Curr Opin Crit Care 14: 279-286, 2008.
Kim W Y, Kwak M K, Ko B S, et al. Factors Associated with the Occurrence of Cardiac Arrest after Emergency Tracheal Intubation in the Emergency Department. Plos One, 9 (11):e112779, 2014.
Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiplecenter study. Crit Care Med 34: 2355-2361, 2006.
Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg 99: 607-613, 2004.
Higgs A, Mcgrath B A, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. British Journal of Anaesthesia, 120 (2):323-352, 2018.
Le Tacon S, Wolter P, Rusterholtz T, et al. Complications of difficult tracheal intubations in a critical care unit. Ann Fr Anesth Reanim 19: 719-724, 2000.
Martin LD, Mhyre JM, Shanks AM, et al. 3, 423 emergency tracheal intubations at a university hospital: airway outcomes and complications. Anesthesiology 114: 42-48, 2011.
Liem E, Bjoraker D, Gravenstein D. New options for airway management: intubating fiberoptic stylets. Br J Anaesth 91: 408-418, 2003.
Shikani AH. New “seeing” stylet-scope and method for the management of the difficult airway. Otolaryngol Head Neck Surg 120: 113-116, 1999.
Stricker P, Fiadjoe JE, McGinnis S. Intubation of an infant with Pierre Robin sequence under dexmedetomidine sedation using the Shikani Optical Stylet. Acta Anaesthesiol Scand 52: 866-867, 2008.
Langeron O, Amour J, Vivien B, Aubrun F. Clinical review: management of difficult airways. Crit Care 10: 243, 2006.
Jansen AH, Johnston G. The Shikani Optical Stylet: a useful adjunct to airway management in a neonate with popliteal pterygium syndrome. Paediatr Anaesth 18: 188-190, 2008.
Shukry M, Hanson RD, Koveleskie JR, Ramadhyani U. Management of the difficult pediatric airway with Shikani Optical Stylet. Paediatr Anaesth 15: 342-345, 2005.
Tan Y, Tang W, Anesthesiology D O. The application of Shikani Seeing Optical Stylet in difficult airway intubation in children. Journal of Modern Medicine & Health, 2014.
Hernandez G, Peña H, Cornejo R, et al. Impact of emergency intubation on central venous oxygen saturation in critically ill patients: a multicenter observational study [J]. Critical Care, 2009, 13:R63.
Xue FS, Liu HP, He N, et al. Spray-as-you-go airway topical anesthesia in patients with a difficult airway: a randomized, double-blind comparison of 2% and 4% lidocaine. Anesth Analg 108: 536-543, 2009.
Valverde C M D L L, López F G, Sánchez A T, et al. Lighted stylet tracheal intubation. Actualizaciones En Anestesiologia Y Reanimacion, 14:123-126, 2004.
Williams B A, Kentor M L, Williams J P, et al. PACU bypass after outpatient knee surgery is associated with fewer unplanned hospital admissions but more phase II nursing interventions.[J]. Anesthesiology, 2002, 97 (4):981.
Yang D, Tong SY, Jin JH, et al. Shikani optical stylet-guided intubation via the intubating laryngeal airway in patients with scar contracture of the face and neck. Chin Med Sci J 28: 195-200, 2013.
Phua DS, Mah CL, Wang CF. The Shikani optical stylet as an alternative to the GlideScope® videolaryngoscope in simulated difficult intubations--a randomised controlled trial. Anaesthesia 67: 402-406, 2012.
Young CF, Vadivelu N. Does the use of a laryngoscope facilitate orotracheal intubation with a Shikani Optical Stylet? Br J Anaesth 99: 302-303, 2007.
Yao YT, Jia NG, Li CH, et al. Comparison of endotracheal intubation with the Shikani Optical Stylet using the left molar approach and direct laryngoscopy. Chin Med J (Engl) 121: 1324-1327, 2008.
Xue FS, He NL, Jian H, et al. Awake orotracheal intubation with the Bonfils fibrescope in patients with a difficult airway. Eur J Anaesthesiol 27: 305-306, 2010.
Abdellatif AA, Ali MA. GlideScope videolaryngoscope versus flexible fiberoptic bronchoscope for awake intubation of morbidly obese patient with predicted difficult intubation. Middle East J Anaesthesiol 22: 385-392, 2014.
Mosier JM, Whitmore SP, Bloom JW, et al. Video laryngoscopy improves intubation success and reduces esophageal intubations compared to direct laryngoscopy in the medical intensive care unit. Crit Care 17: R237, 2013.
Griesdale DE, Liu D, McKinney J, Choi PT. Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review andmeta-analysis. Can J Anaesth 59: 41–52, 2012.
Evans A, Morris S, Petterson J, et al. A comparison of the Seeing Optical Stylet and the gum elastic bougie in simulated difficult tracheal intubation: a manikin study. Anaesthesia 61: 478-481, 2006.
Turkstra TP, Pelz DM, Shaikh AA, et al. Cervical spine motion: a fluoroscopic comparison of Shikani Optical Stylet vs Macintosh laryngoscope. Can J Anaesth 54: 441-447, 2007.
Dupanovic M, Fox H, Kovac A. Management of the airway in multitrauma. Curr Opin Anaesthesiol 23: 276-282, 2010.
Aghdaii N, Azarfarin R, Yazdanian F, et al. Cardiovascular responses to orotracheal intubation in patients undergoing coronary artery bypass grafting surgery. Comparing fiberoptic bronchoscopy with direct laryngoscopy. Middle East Journal of Anesthesiology, 20:833-8, 2010.
Jeon Y G, Park J, Kim M H, et al. Hemodynamic response to tracheal intubation and postoperative pharyngeal morbidity using GlideScope ®, Lightwand and Macintosh laryngoscopes during remifentanil infusion. 12:342-347, 2017.
Brooks S M. Perspective on the human cough reflex. Cough, 7:10, 2011.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186