Comparison of three tracheal intubation techniques in thyroid tumor patients with a difficult airway: a randomized controlled trial

ABSTRACT

To investigate the effectiveness of the Shikani optical stylet [SOS] and Glide Scope video laryngoscope [GVL] for tracheal intubation of thyroid tumor patients with a difficult airway. One hundred and twenty thyroid tumor patients with a difficult airway, who were undergoing elective surgery requiring general anesthesia, were enrolled in the study. They were randomly allocated to 3 groups [n = 40 each] who underwent direct laryngoscopy [DL], SOS or GVL. The outcomes recorded were time to intubation, first-attempt success rate, mean artery pressure [MAP], heart rate [HR] and incidence of complications. The mean time to intubation in the SOS group [group S; 42.4 +/- 24.1 s] and the GLV group [group G; 29.8 +/- 22.3 s] was significantly less than that in the DL group [group D] [68.8 +/- 26.6 s]. The first-attempt success rate in group S [90.0%] and group G [97.5%] was significantly higher than that in group D [75.0%; all p < 0.05]. The HR and MAP at 1 min after intubation were lowest in group S [76.4 +/- 9.2 beats/min and 12.9 +/- 1.1 kPa], followed by group G [79.9 +/- 9.3 beats/min and 13.0 +/- 0.9 kPa] and then group D [90.4 +/- 8.1 beats/min and 16.6 +/- 1.2 kPa]. The difference was statistically significant [all p < 0.05]. The incidence of lip or mucosal trauma was lowest in group S, followed by group G and then group D. The SOS and the GLV had advantages over the DL in the management of thyroid tumor patients with a difficult airway in terms of a shorter time to intubation, a higher first-attempt success rate and a reduced incidence of complications. Thus, a rational choice of one of these techniques may be better for the perioperative safety of thyroid tumor patients with a difficult airway