A Paradigm Shift of Airway Management: The Role of Video-Assisted Intubating Stylet Technique

Difficult or failed intubation is a major contributor to morbidity for patients and to liability for the provider. Research to improve understanding, prevention, and management of such complications remains an anesthetic priority, and a driving force behind continuous improvements in intubation techniques and intubation equipment. The purpose of this review article is to focus on the video-assisted intubating stylet technique (VS; also known as the Shikani optical stylet technique for intubation) and video-assisted optical stylet devices, both for routine use and alternative rescue application for tracheal intubation, and stress their advantages as compared to conventional direct laryngoscopy and videolaryngoscopy. The VS technique was introduced by Dr. Alan Shikani in 1996 and popularized with the advent of the Shikani optical stylet and subsequent similar stylets variations. We focus on the clinical details of the technique itself, and on the various advantages and troubleshooting under different clinical scenarios and practice settings. In our experience, video-assisted intubating stylet technique often constitutes the most appropriate approach both for daily routine and emergency airway management. Furthermore, we also emphasize the importance of video-assisted intubating stylets in enhancing the practitioner systems response when difficult or failed tracheal intubation is encountered

Mechanical Characterization of Rabbit Pulmonary Vein Sleeves in In Vitro Intact Ring Preparation

BackgroundPulmonary vein (PV) sleeves, composed of cardiomyocytes, play certain roles in arrhythmogenesis. In the literature, it has been frequently reported that PV sleeves possess intrinsic spontaneous pacemaking activity and triggered activity in normal dogs and rabbits. In contrast, other research groups presented totally opposite findings which showed absence of such pacemakers in dogs, rabbits and rats. The present study was designed to clarify this puzzle and contradiction.MethodsA novel methodology using in vitro experimentation was used to examine the electromechanical activity of whole segments of PV sleeves. The ring preparation was composed of a small piece of left atrial (LA) free wall, PV ostium and sleeve from rabbits. A circumferential contraction of the PV sleeve was measured when the preparation was electrically driven from the LA free wall. Mechanical force of the ring preparation was measured using a force transducer. The action potentials were recorded using conventional intracellular recording technique in strip preparation.ResultsIn 15 rabbits, no spontaneous pacemaking activity or triggered activity was found in the in vitro ring preparation of PV sleeve. The circumferential contraction of PV sleeves was external calcium-dependent. Frequency-force relation displayed a negative staircase at 0.1–0.5 Hz and a positive staircase at 1–5 Hz. Post-rest potentiation was prominent between 15 s and 120 s. Intracellular action potential recording did not display any automaticity or triggered activity in PV sleeves.ConclusionIn an intact ring preparation of rabbit PV sleeves, intrinsic spontaneous pacemaking activity or triggered activity was not found

Promotion Effect of Palladium on BiVO4 Sensing Material for Epinephrine Detection

In this study, the Pd/BiVO4 composite was prepared by hydrothermal method as an electrochemical sensing material for epinephrine. X-ray diffraction, scanning electron microscopy, and a transmission electron microscope were used to characterize the samples. In the electrochemical detection system, cyclic voltammetry and differential pulse voltammetry were applied to measure the concentration of the epinephrine solution (0.9–27.5 µM) with the Pd/BiVO4-coated glassy carbon electrode. As a result, the oxidation peak current of Pd/BiVO4/GCE demonstrated good linearity with the epinephrine concentration. The detection limit of the epinephrine concentration by cyclic voltammetry and differential pulse voltammetry were 0.262 µM and 0.154 µM, respectively. Additionally, the proposed sensing material exhibited good reproducibility, stability, and selectivity. A plausible sensing mechanism was proposed

Sheet Barrier and Intubating Stylet

Coronavirus disease 2019 (COVID-19), a respiratory syndrome caused by SARS-CoV-2, can be transmitted through respiratory droplets and aerosols of droplet nuclei. Aerosol-generating medical procedures (AGMP) are needed to take care of critically ill patients but place health care providers at risk of infection. With limited supplies of personal protective equipment (PPE), barrier systems were developed to help protect health care providers during tracheal intubation. The video intubating stylet shows promise to become the preferred intubation device in conjunction with plastic sheet barriers during the COVID-19 pandemic

Sheet Barrier and Intubating Stylet

Coronavirus disease 2019 (COVID-19), a respiratory syndrome caused by SARS-CoV-2, can be transmitted through respiratory droplets and aerosols of droplet nuclei. Aerosol-generating medical procedures (AGMP) are needed to take care of critically ill patients but place health care providers at risk of infection. With limited supplies of personal protective equipment (PPE), barrier systems were developed to help protect health care providers during tracheal intubation. The video intubating stylet shows promise to become the preferred intubation device in conjunction with plastic sheet barriers during the COVID-19 pandemic

Styletubation in Bariatric Surgery: A Case Report

Direct laryngoscopes and videolaryngoscopes are the dominant endotracheal intubation tools. The styletubation technique (using a video-assisted intubating stylet) has shown its advantages in terms of short intubation time, high success rate, less required stimulation, and operator satisfaction. The learning curve can be steep but is easily overcome if technical pitfalls are avoided. Conditions that make styletubation challenging include secretions/blood, short/stiff neck, restricted mouth opening and cervical spine mobility, anatomical abnormalities over head and neck regions, obesity, etc. In this clinical report, we present the effectiveness and efficiency of the routine use of the styletubation for tracheal intubation in a super-super-obese patient (BMI 103 kg/m2) undergoing bariatric surgery with laparoscopic sleeve gastrectomy

The Use of a Video-Assisted Intubating Stylet Technique in a Critically Ill and Contagious COVID-19 Patient

Tracheal intubation and ventilatory support are among the important treatments in patients infected with COVID-19 with acute respiratory distress syndrome (ARDS) and severe hypoxia. The intubating team often uses video-assisted intubation equipment to ensure a safe and successful tracheal intubation. In this case report, we demonstrate for the first time, the use of the Shikani video-assisted intubating stylet and the Shikani intubating technique as a safe, speedy, and effective way to intubate a critically ill and highly contagious COVID-19 patient. In addition to the conventional consensus guidelines that are currently available for good practice (such as the proper use of personal protection equipment, etc.), we demonstrated that using the Shikani video-assisted intubating stylet is a reliable and proficient technique that is easy to learn while minimizing the risk of COVID-19 exposure of the airway personnel

Lung Point-of-Care Ultrasound for Unexpected Hypoxemia during Anesthesia

This is a case report showing acute hypoxemia during anesthesia. Immediate differentiation using lung POCUS (point-of-care ultrasound), in addition to physical examination and portable chest radiography, was made. This is the first case report of sputum impaction due to pneumonia causing hypoxemia that has been detected by lung POCUS during anesthesia

Video-Assisted Intubating Stylet Technique for Difficult Intubation: A Case Series Report

Induction of anesthesia can be challenging for patients with difficult airways and head or neck tumors. Factors that could complicate airway management include poor dentition, limited mouth opening, restricted neck motility, narrowing of oral airway space, restricted laryngeal and pharyngeal space, and obstruction of glottic regions from the tumor. Current difficult airway management guidelines include awake tracheal intubation, anesthetized tracheal intubation, or combined awake and anesthetized intubation. Video laryngoscopy is often chosen over direct laryngoscopy in patients with difficult airways because of an improved laryngeal view, higher frequency of successful intubations, higher frequency of first-attempt intubation, and fewer intubation attempts. In this case series report, we describe the video-assisted intubating stylet technique in five patients with difficult airways. We believe that the intubating stylet is a feasible and safe airway technique for anesthetized tracheal intubation in patients with an anticipated difficult airway

Video-Assisted Intubating Stylet Technique for Difficult Intubation: A Case Series Report

Induction of anesthesia can be challenging for patients with difficult airways and head or neck tumors. Factors that could complicate airway management include poor dentition, limited mouth opening, restricted neck motility, narrowing of oral airway space, restricted laryngeal and pharyngeal space, and obstruction of glottic regions from the tumor. Current difficult airway management guidelines include awake tracheal intubation, anesthetized tracheal intubation, or combined awake and anesthetized intubation. Video laryngoscopy is often chosen over direct laryngoscopy in patients with difficult airways because of an improved laryngeal view, higher frequency of successful intubations, higher frequency of first-attempt intubation, and fewer intubation attempts. In this case series report, we describe the video-assisted intubating stylet technique in five patients with difficult airways. We believe that the intubating stylet is a feasible and safe airway technique for anesthetized tracheal intubation in patients with an anticipated difficult airway