A Paradigm Shift of Airway Management: The Role of Video-Assisted Intubating Stylet Technique

Difficult or failed intubation is a major contributor to morbidity for patients and to liability for the provider. Research to improve understanding, prevention, and management of such complications remains an anesthetic priority, and a driving force behind continuous improvements in intubation techniques and intubation equipment. The purpose of this review article is to focus on the video-assisted intubating stylet technique (VS; also known as the Shikani optical stylet technique for intubation) and video-assisted optical stylet devices, both for routine use and alternative rescue application for tracheal intubation, and stress their advantages as compared to conventional direct laryngoscopy and videolaryngoscopy. The VS technique was introduced by Dr. Alan Shikani in 1996 and popularized with the advent of the Shikani optical stylet and subsequent similar stylets variations. We focus on the clinical details of the technique itself, and on the various advantages and troubleshooting under different clinical scenarios and practice settings. In our experience, video-assisted intubating stylet technique often constitutes the most appropriate approach both for daily routine and emergency airway management. Furthermore, we also emphasize the importance of video-assisted intubating stylets in enhancing the practitioner systems response when difficult or failed tracheal intubation is encountered.