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A New "Seeing" Stylet-Scope and Method
for the Management of the Difficult Airway
by
Alan H. Shikani MD, FACS
From the department of Otolaryngology-Head & Neck Surgery, The
Johns Hopkins Medical Institutions, Chief, Division of Otolaryngology-Head
& Neck Surgery, The Good Samaritan Hospital and the Union memorial
Hospital, Baltimore, Maryland 21239.
Abstract:
Endotracheal intubation may be complicated by trauma to the glottis,
hypopharynx or dentition, or even more serious complications including
aspiration, hypoxemia and brain damage, if a patent airway cannot
be achieved. In this paper, a new intubating stylet-scope is introduced,
offering the ability to continuously visualize the airway during
introduction of the endotracheal tube into the glottis, hence minimizing
the risk of injury. The stylet has a lens at its distal end, and
body consisting of a malleable metal cannula with a fiberoptic cable
inside, connected to a camera and a video monitor. This new device
combines the advantages of the classic wire-stylet, the light wand,
and the flexible fiberoptic scope. In addition to facilitating and
teaching the management of the difficult airway, it allows the introduction
of a new technique for intubation, whereby the mandible is lifted
with the left hand and displaced anteriorly until the lower teeth
are anterior to the upper teeth, the glottis is directly visualized
and the endotracheal tube driven into the trachea, without the need
of the rigid laryngoscope blade to retract the base of the tongue.
Directions For Use
The Shikani Jaw-lift technique of intubation using the SOS:
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The head is initially in the resting
position.
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The head is placed in the sniff
position and the mandible in lifted utilizing the left hand.
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The stylet, preloaded with the
endotracheal tube, is inserted into the mouth utilizing
the right hand and the larynx is visualized.
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The stylet-ET tube unit is advanced
through the vocal
cords under direct visualization and the stylet is removed.
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Key Words: Stylet, scope, intubation, difficult airway.
Reference: Shikani Alan H., Otolaryngology-Head and Neck Surgery
January 1999 o Volume 120 Number 1, New "seeing" stylet-scope
and method for the management of the difficult airway
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