Prospective observational study evaluating the C-MAC Video Stylet for awake tracheal intubation: a single-center study.

Nabecker, Sabine; Ottenhausen, Thora; Theiler, Lorenz; Braun, Matthias; Greif, Robert; Riva, Thomas

BACKGROUND Gold standard for management of known or predicted difficult airways is awake tracheal intubation. The newly developed C-MAC Video Stylet promises to combine the advantages of rigid stylets and flexible optical scopes. We therefore evaluated the feasibility of awake orotracheal intubations with this device. METHODS In this prospective observational study, three anesthesiologists experienced in advanced airway management performed each 12 awake oral intubations with this device on adult patients with known or predicted intubation difficulties. The primary outcome was overall intubation success. Secondary outcomes were total attempts, successful time, first post-operative day sequelae, and subjective intubation difficulty rated on a visual analogue scale (1, very easy; 10, extremely difficult). RESULTS Ten (28%) patients were female, aged 64 +/-13 years, with BMI 26 +/- 5 kg.m- 1. ASA status (II/III/IV) was 8 (22%) /, 23 (64%) / 5 (14%). Indications for awake oral intubation were: oropharyngeal tumor 20 (56%), cervical-spine fracture 8 (22%), previously known difficult airway 4 (11%), spinal canal stenosis 3 (8%), and bilateral peritonsillar abscess 1 (3%). Overall 97% were successfully intubated in 45 s (31-88). First-attempt success rate was 80% in 37 s (29-54); 92% of patients would choose the same procedure again. On the first post-operative day, 11 (31%) patients complained of sore throat; 5 (14%) had minor injuries. Ease of intubation was rated as median VAS (IQR) 3 (1-7). CONCLUSIONS The new C-MAC Video Stylet has the potential to serve as a suitable device for visualized oral awake intubation in difficult airway situations.