Comparison between stylet and bougie with the C-MAC D-blade in cervical simulated immobility. A prospective randomized controlled trial

Keywords: Video laryngoscope, Intubation, Bougie, stylet, Limited cervical movements, Anesthesiology

Abstract

Introduction: The C-MAC D-blade was designed for difficult airway intubation scenarios. To facilitate easier and faster endotracheal intubation in the laryngoscopy paradox, an introducer is preferred. Hence, we decided to conduct a study to compare the 60˚ angled C-MAC stylet and the gum elastic bougie as aids to intubation while using the C-MAC D-blade laryngoscope in a simulated difficult airway setting.

Objective: To compare the ease of oral intubation with the use of the C-MAC stylet (60˚ angled stylet) versus intubation performed over a bougie inserted using the C-MAC D-blade guidance in patients with simulated restricted cervical mobility.

Methods: Prospective, randomized controlled single-center study. Intubation using the C-MAC D-blade laryngoscope was performed in 48 surgical patients randomly assigned to 2 groups of 24 each: Stylet group, Group S (using 60˚ angled stylet) and Bougie group, Group B (using bougie) after providing manual in-line stabilization to restrict cervical mobility. The Mann-Whitney U test and the Chi square test were used as applicable. 

Results: The use of stylet resulted in easier (Group S 75% vs. Group B 16.7%) and faster (Group S 26.83 ± 8.61s vs. Group B 47.18 ± 16.46s) intubation with fewer attempts compared to group B. Both groups experienced a similar hemodynamic stress response to intubation.

Conclusions: The 60˚ angled C-MAC Stylet is a more effective and time-saving intubation aid with C-MAC D-blade compared to bougie.

References

Cavus E, Neumann T, Doerges V, Moeller T, Scharf E, Wagner K, et al. First clinical evaluation of the C-MAC D-blade video laryngoscope during routine and difficult intubation. Anesth Analg 2011; 112:382-5. doi: https://doi.org/10.1213/ANE.0b013e31820553fb

Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011; 106:617-631. doi: https://doi.org/10.1093/bja/aer058

Dilek Ömür, Başak Bayram, Şule Özbilgin, Volkan Hancı, Bahar Kuvaki, Comparison of different stylets used for intubation with the C-MAC D-Blade® Videolaryngoscope: a randomized controlled study. Brazilian Journal of Anesthesiology 2017; 67:450-6. doi: https://doi.org/10.1016/j.bjane.2016.06.001

Gupta N, Rath GP, Prabhakar H. Clinical evaluation of C MAC videolaryngoscope with or without use of stylet for endotracheal intubation in patients with cervical spine immobilization. J Anesth 2013; 27:663 70. doi: https://doi.org/10.1007/s00540-013-1588-6

Tosh P, Rajan S, Kumar L. Ease of Intubation with C-MAC Video laryngoscope: Use of 60° Angled Styletted Endotracheal Tube versus Intubation over Bougie. Anesthesia, Essays and Researches. 2018; 12:194-198. doi: https://doi.org/10.4103/aer.AER_121_17

Batuwitage B, McDonald A, Nishikawa K, Lythgoe D, Mercer S, Charters P. Comparison between bougies and stylets for simulated tracheal intubation with the C-MAC D-blade videolaryngoscope. Eur J Anaesthesiol 2015; 32:400-5. doi: https://doi.org/10.1097/EJA.0000000000000070

Özkan D, Altınsoy S, Sayın M, Dolgun H, Ergil J, Dönmez A. Comparison of cervical spine motion during intubation with a C MAC D Blade® and an LMA Fastrach®. Anaesthesist. 2019; 68: 90-96.doi: 10.1007/s00101-018-0533-3. doi: https://doi.org/10.1007/s00101-018-0533-3

Mani N, Palanisamy N, Zachariah M, George SK, Dsilva AA, Johns JR. C-MAC D-Blade vs Airtraq for Intubation with Manual Inline Axial Stabilisation- A Randomised Clinical Trial. Journal of clinical and diagnostic research; 2021;15:UC01-04. doi: http://dx.doi.org/10.7860/jcdr/2021/46676.14393

Rao M, Nileshwar A, N Nandeesha. Comparison of the C-MACTM 'D' blade with AirTraq® for endotracheal intubation in patients with simulated limitation of cervical movements. Ind J Resp Care 2014; 3:357-63.

Sheu YJ, Yu SW, Huang TW, Liu FL, Lin YK, Tam KW. Comparison of the efficacy of a bougie and stylet in patients with endotracheal intubation: A meta-analysis of randomized controlled trials. J Trauma Acute Care Surg 2019; 86:902-8. doi: https://doi.org/10.1097/TA.0000000000002216

Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET et al. Effect of use of a bougie vs endotracheal tube and stylet on first -attempt intubation success among patients with difficult airways undergoing emergency intubation: a randomized clinical trial. JAMA 2018;319(21);2179-89. doi: https://doi.org/10.1001/jama.2018.6496

How to Cite
1.
Thevar Manoharan NS, Varghese N, Krishna Bhat RR. Comparison between stylet and bougie with the C-MAC D-blade in cervical simulated immobility. A prospective randomized controlled trial. Colomb. J. Anesthesiol. [Internet]. 2023 Mar. 3 [cited 2024 Feb. 26];51(2). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1061

Downloads

Download data is not yet available.
Published
2023-03-03
How to Cite
1.
Thevar Manoharan NS, Varghese N, Krishna Bhat RR. Comparison between stylet and bougie with the C-MAC D-blade in cervical simulated immobility. A prospective randomized controlled trial. Colomb. J. Anesthesiol. [Internet]. 2023 Mar. 3 [cited 2024 Feb. 26];51(2). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1061
Section
Original

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code

Some similar items: