A Better Stylet Design for Videolaryngoscopes in Patients with Difficult Airway

Videolaryngoscopes are being used with increasing frequency in patients with known or anticipated difficult airway [1]. While they usually provide excellent glottic visualization, directing an endotracheal tube through the vocal cords can be challenging [2]. Additionally, airway trauma has been reported with the Glidescope rigid stylet [3-5]. A recent report described the use of a fiberoptic bronchoscope as a stylet during endotracheal intubation of a patient with a difficult airway while the glottis was visualized through the Glidescope videolaryngoscope [6]. After reading that report, we have used this technique multiple times with both the Glidescope and the Airtraq laryngoscope and have found that a fiberoptic bronchoscope functions as the ideal maneuverable stylet during videolaryngoscopy. The softness of the tip of the fiberoptic bronchoscope minimizes its potential for causing trauma, while the flexibility of its tip facilitates the negotiation of acute angles that other stylets may fail to negotiate.