Difficult airway management: comparison of the Bullard laryngoscope with the video-optical intubation stylet

Purpose: To evaluate, whether the video-optical intubation styler (VOIS) was more successful for difficult tracheal intubation than the Bullard laryngoscope (BL). Methods: An intubation mannequin head was modified so that, using a Macintosh blade size 3, only the epiglottis was visible at direct laryngoscopy, representing a grade ill laryngoscopic view. Forty anesthesiologists attempted tracheal intubation using each technique. Tracheal intubation with the Bullard laryngoscope was performed using the attached non-malleable intubating stylet preloaded with an endotracheal tube. The video-optical intubation stylet inserted into an endotracheal tube was used with direct laryngoscopy. During conventional laryngoscopy, the video-view from the stylet tip allowed the tracheal tube to be guided behind the epiglottis into the trachea. Ten attempts with each technique were performed by each anesthesiologist in randomized order, Intubation time, and failed intubation (> 60 sec / esophageal intubation) were recorded. The operators assessed the degree of difficulty of each method using a Likert-scale. Results: Mean intubation time (19.2 +/- 4.5 sec for the BL and 18.8 +/- 4.6 sec for the VOIS) was almost the identical. The video-optical intubation stylet was associated with fewer railed intubations (8 vs 41; P < 0.005) and had a lower degree of difficulty (1.7 +/- 0.65 for the VOIS and 2.6 +/- 0.74 for the BL; P < 0.0001), No correlation was found between the anesthesiologist's experience and mean intubation time, estimated degree of difficulty or number of unsuccessful intubation. Conclusion: The video-optical intubation stylet was a more effective and simpler intubation device to facilitate difficult tracheal intubation than the Bullard laryngoscope.