The Shikani Optical Stylet Experience with the first 100 patients

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The Shikani Optical StyletExperience with the
first 100 patients

• Samuel Metz, MD
• Oregon Anesthesiology Group
• Portland, Oregon

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Methods

• 20 minute DVD viewed once, 5 pilot uses
• 100 consecutive adult patients, multiple
  institutions
• Anticipated difficult intubations noted
• Time from lifting the stylet from the machine to
  replacing it
• Oxygen insufflation not used
• Cleaned in 70 alcohol between cases by me

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Population of patients

• Use of direct laryngoscopy
• Double lumen endobronchial tube
• Battery failure in stylet
• Anticipated difficult intubations 35
• Obesity 33
• Preinduction secretions 1
• Limited neck movement 1

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Prior studies

• Agro F, Cataldo R, Carassiti M, Costa F. The
  seeing stylet a new device for tracheal
  intubation. Resuscitation 2000 44177-80
• Shikani AH. New seeing stylet-scope and method
  for the management of the difficult airway.
  Otolaryngol Head Neck Surg 1999 120113-6
• Young CF, Rosenblatt WH. A better mousetrap?
  Evaluation of the user interface, complications,
  and efficacy of the Shikani Optical Stylet for
  orotracheal intubation. Unpublished data.

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Results

• Failure to intubate 1 out of 100
• Emergent, obese patient
• Trauma 1 out of 100
• Complications 2 out of 100
• Esophageal intubation
• Aspiration
• Timed intubations 65
• Average time 30
  seconds
• Median time 22 seconds

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Results

• Anticipated difficult intubations 35
• Timed intubations 21
• Average 32 sec
• Median 25 sec

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Comparative intubation times
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Technique lessons learned

• Anti-fog
• Test vision see tip of ETT in field of vision
• Suction first
• Look early consider head down, camera, or
  lateral insertion
• Stay midline
• See ETT and trachea together

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Disadvantages of Shikani Stylet

• More secretion sensitive
• Larger cavity with direct laryngoscopy
• Free hand for suction with direct laryngoscopy
• Use of oxygen insufflation to improve vision?
• Cannot insert double lumen endobronchial tube

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Advantages of Shikani Stylet

• Easier to learn and teach
• Less potential trauma
• One size fits all adults
• Requires no neck movement, minimal mouth opening
• Requires one person only
• May function as lighted stylet with secretions?
• Confirm tracheal placement, clear trachea
• Potentially higher success with difficult airways
• Easy to clean

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Comparative cost

• 10 ORs, 1 airway cart, stocked work room
• 40 handles, 70 each 2,800
• 120 blades, 110 each 13,200
• Labor cost of cleaning ?
• 12 Shikani scopes 24,000

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Conclusions so far

• Faster intubation technique to learn
• More likely success in difficult airways than DL
• Less trauma, more versatile than DL
• 1st choice for normal elective intubations