• Jaime E Moore, Amanda Hu, Amy Rutt, Parmis Green, Mary Hawkshaw, and Robert T Sataloff.
• Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia.
• Laryngoscope. 2015 Feb 1;125(2):396-9.

Objectives/HypothesisVocal fold injury is a well-know complication of intubation, with rates reported as high as 69%. Laryngology textbooks recommend the use of a small endotracheal tube (ETT) to help avoid these complications and optimize visualization. Case reports have suggested that the rigid stylet can lead to laryngeal injury. Given the additional risks, intubation without the stylet is our preferred practice. There is limited documentation in the literature regarding this viewpoint. Our study investigated the feasibility of and potential barriers to intubation using 5.0 ETT without a stylet.Study DesignProspective study.MethodsConsecutive adult patients undergoing laryngeal surgery were recruited for intubation with a 5.0 ETT without a stylet. Demographic data, specialty and training level of the intubator, and factors that would predict a difficult intubation were recorded. Descriptive statistical analysis was performed.ResultsFindings of the participants (n = 67) included average American Society of Anesthesiologists (ASA) physical status classification (2.2), average Mallampati score (1.7), average Cormack-Lehane grade (1.5), and average body mass index (28.0). Five patients (7.4%) required intubation using a stylet, and one of these five participants was intubated initially with a stylet. Of these five participants, 80% required use of a GlideScope (P < .001), and they had significantly higher ASA classification (P = .047) and number of intubation attempts (P = .042). One patient sustained an oropharyngeal injury during intubation with a stylet. No participants had laryngeal injury.ConclusionsMost patients can be intubated successfully using a 5.0 ETT without a stylet. There were no cases of laryngeal trauma with this technique.Level Of Evidence2b.© 2014 The American Laryngological, Rhinological and Otological Society, Inc.

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