GlideRite® rigid stylet vs Flex-it® articulated stylet for intubation with videolaryngoscopy in patients with semi-rigid cervical collar: a randomized trial.

BACKGROUND: Compared with the GlideRite® rigid stylet used with the GlideScope® hyperangulated blade, the Flex-it® stylet permits dynamic orientation of the tracheal tube toward the glottis. This randomized trial compared GlideRite and Flex-it stylets regarding GlideScope intubation duration in patients wearing a semi-rigid cervical collar, simulating conditions of cervical instability. METHODS: Eighty adult patients undergoing elective surgery were randomized to tracheal intubation using the GlideScope with either the GlideRite or the Flex-it stylet. A semi-rigid cervical collar was applied following anesthesia induction. The primary endpoint was intubation duration in seconds. For our modified Intention-To-Treat (mITT) analysis, failed intubations were assigned the maximum duration of 180 seconds. Secondary outcomes included tracheal tube handling duration, intubation failure, Intubation Difficulty Scale, and ease of stylet removal. RESULTS: Seventy-five patients were included in the mITT analysis (n = 38 for Flex-it, 37 for GlideRite). Intubation duration was longer when using Flex-it compared with GlideRite (median [IQR]: 88 [65‒180] vs. 49 [39‒61]s) with a median difference of 37 s (95% CI: 22 to 64; p < 0.0001). Tube handling duration was longer with Flex-it (median [IQR]: 48 [33‒66] vs. 34 [25‒39]s; p = 0.007). Failure rate was significantly higher with Flex-it (15/38, 39.5%) than with GlideRite (2/37, 5.4%; p < 0.001. Intubation Difficulty Scale score was higher for Flex-it (median [IQR]: 6 [5‒7] vs. 2 [2‒5]; p < 0.001). CONCLUSION: In elective patients with simulated cervical instability, videolaryngoscopy with the Flex-it stylet resulted in longer intubation, greater difficulty, and higher failure rate compared with the GlideRite stylet.