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Steerable semi-rigid video stylet for tracheal intubation

The SensaScope

Difficulty with tracheal intubation is a major cause of anaesthesia-related morbidity and mortality. Patients with predicted difficult tracheal intubation can be managed safely and reliably using a flexible fibreoptic laryngoscope. However, no technique has proven completely reliable for managing unanticipated difficult intubation, which occurs after induction of anaesthesia and under complete neuromuscular blockade. Problems encountered with flexible fibreoptic intubations are often a consequence of difficulty in rotating or advancing the scope because its shaft is too floppy. This feature also contributes to difficulty in railroading the tracheal tube (TT). However, the combination of a rigid shaft with a steerable tip provides the advantages of both systems while avoiding the problems of a completely flexible system.

The SensaScope is a new guidable and partially rigid video stylet designed to perform intubation under vision on a video screen. The 43-cm long lightweight video stylet features a rigid metal S-shaped shaft. It has a steerable tip that can be flexed in the sagittal plane in both directions by operating a lever at the proximal end of the device. The proximal end also consists of an eyepiece on which a CCD video camera can be mounted and a light cable connector. The TT has to be mounted on the scope. Intubation with the new instrument is an extension of conventional laryngoscopy in that it is manoeuvred with the right hand, while the left performs conventional laryngoscopy with a laryngoscope. It offers simultaneous direct and endoscopic view of the glottis, visual control over the passage of the TT and confirmation of its final tracheal position. There is no need for extreme head-extension or forced traction of the laryngoscope, which may cause dental injury or adverse cardio-vascular responses. As a consequence of the metallic surface of the device, it is not necessary to use a lubricant for railroading the TT. The anatomical shape of the shaft has been designed to facilitate smooth and secure insertion into the trachea. When the tracheal bifurcation is visible on the screen, the instrument is held firmly and the TT is railroaded carefully into the trachea with the left hand until it appears on the screen. The TT position is then adjusted under direct visual control. Finally, the instrument is removed while holding the TT firmly in place.

The unique combination of properties suggests that the technique is easy to learn and that it has great potential to make airway management safer than is the case with direct laryngoscopy alone. In unanticipated difficult intubation situations after induction of anaesthesia, the device can be assembled rapidly and used almost immediately. The instrument can be used to monitor routine tracheal intubation and to improve the success rate of unanticipated difficult tracheal intubation.

Acutronic Medical Systems

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