Optical stylet intubations two ways by Master DuCanto
Here are two videos of intubations using optical stylets : The Clarus Video Stylet via an AirQ SGA and the original Levitan FPS stylet ( from which the Clarus VS is modelled)
Note use of Oxylator for preoxygenation and the S Shaped bend Jim molded the Clarus VS into to facilitate passage down the AirQ channel.
Note use of Glidescope to visualise epiglottis, then use of Levitan stylet to endoscope the trachea
Relevance to Prehospital and Retrieval medicine:
So what I hear you cry? DuCanto has the luxury of a nicely lit OR with assistants , an anaesthetic machine and monitors to boot. What about my work where I fly into remote clinics and rural hospitals or some cattle station? The fact is that I am aware of at least two Australian retrieval services who do carry the airway gear to do intubations via a LMA/SGA. Cliff Reid’s service has adopted airway gear to intubate via an iGel SGA using a flexible endoscope, the Ambu Ascope. MedStar of South Australia, have for a while been able to carry a flexible fibreoptic bronchoscope and used it successfully in a case of severe clot aspiration post tonsillectomy in a small rural hospital. My service carries the Levitan FPS stylet and this enables us to tube via a LMA. So if a rural nurse of doctor has already placed a LMA before our team arrival, we have options of how we can manage the airway for transport. We can leave the LMA in if it is working fine. We can tube via the LMA using the Levitan for guidance of a bougie or as a stylet. Sure you could just pull the LMA out and try to tube with normal laryngoscopy. But where is the fun in that? Seriously you can continuously ventilate via your LMA with the swivel connector and pass a bougie. Or tubing with the Levitan stylet is quick via the SGA and the SGA itself protects your airway from injury during the intubation.
Comments and questions welcome as always