dr doze

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Had a sales rep drop buy and used an optical style the other day on a few ordinay adult cases. Looks like they may have some game. Any folks who have used them and have opinions either way want to chime in?
 

urge

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I think they are great. Just like a stiff fiberoptic. I have always wanted a Shikani but when I think about it I desist for cost and practical reasons. They go for 1500 more or less. Cleaning it would be a problem. I'll have to clean it myself or give it to the techs which might lose it. Plus I'm sure it will live in my locker far away from where I really need it. The other day I had a kid with a known extremely anterior airway. I could barely see the epiglottis. I would have been nice to go to my locker and grab it.

If I weren't so cheap I would buy one.
 

sevoflurane

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Well, I'm not sure what optical stylet you used, but I can tell you about he shikani. I used it a lot in residency and was happy to find one in our dept. I like it. I'm the only one that uses it however... but mainly for the in between AWs that look ant. If I suspect a truly diff. AW, I go for the glidescope. Shikani are Def. good for ant. Aw's. Great bend distally. Don't forget to hook up O2 tubing to the side port. It gives you a little apnic oxygenation plus it really helps with the lens fogging up.

They are fun to use. :)
 

sevoflurane

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Using O2 @ high flows through the side port also pushes secretions away, keeping your lens muck free. Your f.o lens should land midway through the Murphy's eye of your tube.

For the cost... I think it's worth it. The learning curve is a little tougher than say a glidescope... but not considerably.

Still, for me, the glidescope is my gold standard.
 

sevoflurane

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I'm sure your rep helped you out, but just in case... Once u get through the cords, make sure your left elbow is firmly planted on the head of the bed when you railroad off the stylet. This helps stabilize the stylet and avoids trauma and dislodgement back into the oropharynx.
 

BLADEMDA

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Anaesthesia. 2012 Apr;67(4):402-6. doi: 10.1111/j.1365-2044.2011.07023.x. Epub 2012 Feb 11.
The Shikani optical stylet as an alternative to the GlideScope® videolaryngoscope in simulated difficult intubations--a randomised controlled trial.

Phua DS, Mah CL, Wang CF.
Source

Department of Anaesthesia, Changi General Hospital, Singapore. [email protected]

Abstract

The GlideScope(®) videolaryngoscope is widely utilised in the management of the difficult airway. However, complications such as mucosal injury, palatal and tonsillar perforations have been reported with its use. The Shikani optical stylet has shown promise in aiding difficult intubations. This randomised controlled trial evaluates the Shikani optical stylet as an alternative to the GlideScope videolaryngoscope in patients undergoing anaesthesia, with a simulated difficult airway. Sixty patients were randomised to undergo tracheal intubation with either the GlideScope videolaryngoscope (n = 30) or the Shikani optical stylet (n = 30). All patients had rigid cervical collars applied to simulate a difficult airway. Tracheal intubation was successful in all patients, with first attempt success rates of 97% (29/30) the GlideScope group compared with 93% (28/30) in the Shikani group compared with 93% (28/30) in the Shikani group (p = 0.5). The mean (SD) time to intubation was 64 (37) s when using the GlideScope and 58 (26) s in the Shikani group (p = 0.48). A higher incidence of airway mucosal injury was noted in patients intubated with the GlideScope videolaryngoscope, compared with the Shikani optical stylet (5 vs 0, respectively, p = 0.05). This trial suggests that the Shikani optical stylet is a viable alternative to the GlideScope videolaryngoscope in the management of the difficult airway.
Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland
 

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SaltyDog

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+1 on the Shikani. I use it just like Sevo described. It's also great for pts w/ small mouth openings as you only need enough mouth opening to get the tube through. Jaw thrust is key just like an asleep fiber. That being said I think I'm the only one at my place that likes it.