Determination of the optimal stylet strategy for the C‐MAC® videolaryngoscope

The C‐MAC^® videolaryngoscope is a novel intubation device that incorporates a camera system at the end of its blade, thereby facilitating obtaining a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. It retains the traditional Macintosh blade shape and can be used as a direct or indirect laryngoscope. We wished to determine the optimal stylet strategy for use with the C‐MAC. Ten anaesthetists were allowed up to three attempts to intubate the trachea in one easy and three progressively more difficult laryngoscopy scenarios in a SimMan^® manikin with four tracheal tube stylet strategies: no stylet; stylet; directional stylet (Parker Flex‐It?); and hockey‐stick stylet. The use of a stylet conferred no advantage in the easy laryngoscopy scenario. In the difficult scenarios, the directional and hockey‐stick stylets performed best. In the most difficult scenario, the median (IQR [range]) duration of the successful intubation attempt was lowest with the hockey‐stick stylet; 18 s (15–22 [12–43]) s, highest with the unstyletted tracheal tube; 60 s (60–60 [60, 60]) s and styletted tracheal tube 60 s (29–60 [18–60]) s, and intermediate with the directional stylet 21 s (15–60 [8–60]) s. The use of a stylet alone does not confer benefit in the setting of easy laryngoscopy. However, in more difficult laryngoscopy scenarios, the C‐MAC videolaryngoscope performs best when used with a stylet that angulates the distal tracheal tube. The hockey‐stick stylet configuration performed best in the scenarios tested.