Research Article

Performance of a Portable Intubation Stylet Versus Direct Laryngoscopy: A Randomized Controlled Trial

Abstract

Background: Portable video-assisted intubation devices may help bridge gaps in airway management when conventional video-laryngoscopes (VL) are not readily available. The CamStylet is a lightweight, smartphone-connected video stylet designed to provide real-time visualization without the need for external monitors.
Methods: In this randomized clinical trial, 180 adults undergoing elective surgery were allocated to direct laryngoscopy (DL) or laryngoscopy assisted by the CamStylet. Standardized anesthetic and intubation protocols were used. Intubation time, glottic view, first-attempt success, need for external laryngeal manipulation, and oxygen desaturation were recorded. Data from 176 patients were analyzed.
Results: Intubation time was slightly longer with the CamStylet, but first-pass success was high in both groups. The CamStylet provided a clearer glottic view and markedly reduced the need for external laryngeal pressure. Rates of desaturation and requirement for rescue videolaryngoscopy were low and comparable between groups. No major adverse events occurred.
Conclusion: Although the CamStylet added a few seconds to intubation time, it improved visualization and reduced the need for external manipulation. Its portability and rapid setup may make it a practical adjunct in settings where VLs are limited or unavailable. Further evaluation in difficult airway scenarios is warranted.

[1] Cook TM, Woodall N, Frerk CO. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011; 106(5):617-31.
[2] Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2021; 136(1):31-81.
[3] Higgs A, Cook TM, McGrath BA. Airway management in the critically ill: the same, but different. Br J Anaesth. 2016; 117 Suppl 1:i5-i9.
[4] Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005; 103(2):429-37.
[5] Mort TC. Complications of emergency tracheal intubation: immediate airway-related consequences: part II. J Intensive Care Med. 2007; 22(4):208-15.
[6] Michailidou M, O'Keeffe T, Mosier JM, Friese RS, Joseph B, Rhee P, et al. A comparison of video laryngoscopy to direct laryngoscopy for the emergency intubation of trauma patients. World J Surg. 2015; 39(3):782-8.
[7] Aziz MF, Dillman D, Fu R, Brambrink AM. Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway. Anesthesiology. 2012; 116(3):629-36.
[8] Biro P, Weiss M, Gerber A, Pasch T. Comparison of a new video-optical intubation stylet versus the conventional malleable stylet in simulated difficult tracheal intubation. Anaesthesia. 2000; 55(9):886-9.
[9] Mazères JE, Lefranc A, Cropet C, Steghens A, Bachmann P, Pérol O, et al. Evaluation of the Bonfils intubating fibrescope for predicted difficult intubation in awake patients with ear, nose, and throat cancer. Eur J Anaesthesiol. 2011; 28(9):646-50.
[10] Abdullah HR, Li-Ming T, Marriott A, Wong TG. A comparison between the Bonfils Intubation Fiberscope and McCoy laryngoscope for tracheal intubation in patients with a simulated difficult airway. Anesth Analg. 2013; 117(5):1217-20.
[11] Chen IW, Li YY, Hung KC, Chang YJ, Chen JY, Lin MC, et al. Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis. Medicine (Baltimore). 2022; 101(33):e30032.
[12] Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004; 99(2):607-13.
[13] Gu Y, Zhou Q, Zhou H, Liu M, Feng D, Wei J, et al. A Randomized Study of Rigid Video Stylet versus Macintosh Laryngoscope for Double-Lumen Endobronchial Tube Intubation Assistance in Thoracoscopic Pulmonary Surgery. J Clin Med. 2023; 12(2):540.
[14] Zhang T, Zhao KY, Zhang P, Li RH. Comparison of video laryngoscope, video stylet, and flexible videoscope for transoral endotracheal intubation in patients with difficult airways: a randomized, parallel-group study. Trials. 2023; 24(1):599.
[15] Khajavi M, Kazeroni R, Ramezani R, Biderafsh A, Kianpour P, Neishaboury M. Tracheal intubation with GlideScope vs. Sanyar video laryngoscopes in adults with predicted difficult intubation: a non-inferiority clinical trial. Anaesthesiol Intensive Ther. 2025; 57(1):80-6.
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Keywords
CamStylet Direct Laryngoscopy Clinical Trial Intubation Time.
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1.
Sadrinia A, Neishaboury M, Shariat Moharari R, Etezadi F, Khajavi M, Najafi A, Pourfakhr P. Performance of a Portable Intubation Stylet Versus Direct Laryngoscopy: A Randomized Controlled Trial. Arch Anesth & Crit Care. 2026;.