• Tong Cheng, Li-Kuan Wang, Hai-Yin Wu, Xu-Dong Yang, Xiang Zhang, and Liang Jiao.
• Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China.
• Laryngoscope. 2021 Feb 1; 131 (2): 319-325.

ObjectivesTo evaluate the efficacy and safety of the Shikani optical stylet (SOS) versus fiberoptic bronchoscope (FOB) for awake nasal intubation in head and neck surgery patients with an anticipated difficult airway.Study DesignProspective randomized clinical trial.MethodsThis study involved 50 adult patients scheduled for elective head and neck surgery and presented with an anticipated difficult airway. Patients planned for awake nasotracheal intubation were randomly divided into two groups: FOB (n = 25) and SOS (n = 25). Patients were intubated under local anesthesia and sedation using the randomly assigned intubation device by anesthetists proficient in both airway devices. The time to successful intubation was regarded as the primary endpoint.ResultsThe median time (interquartile range) to tracheal intubation in the FOB group was 74 seconds (57-108) and 38 seconds (27-60) in the SOS group (P < .001). Intubation success rates on the first attempt in the FOB and SOS groups were 96% and 92%, respectively (P > .999). Airway assisted maneuvers were required in six (24%) SOS intubations compared to 21 (84%) FOB intubations (P < .001). There were no significant differences between the groups in the incidences of oxygen desaturation and postoperative complications related to intubation.ConclusionCompared to the FOB group, awake nasal intubation in the SOS group required significantly less time and fewer airway-assisted maneuvers on adult head and neck surgery patients with anticipated difficult airway.Level Of Evidence2 Laryngoscope, 131:319-325, 2021.© 2020 The American Laryngological, Rhinological and Otological Society, Inc.

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