The Role of Optical Stylets

  • Richard Levitan


Optical stylets are versatile airway tools now offered in many different designs that are useful for placing endotracheal tubes (ETTs) and confirming location, either used independently, with laryngoscopes, or with supraglottic airways (SGAs). There are wide variations in optical stylet length, malleability, and light sources. Their only common feature is that they provide imaging through an ETT. As they are passed beyond the vocal cords they all permit tracheoscopy.


Video Screen Bend Angle Tracheal Ring Video Laryngoscope Supraglottic Airway 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Richard Levitan receives royalties on the FPS Levitan Optical Stylet manufactured and sold by Clarus Medical, Minneapolis, MN.


General or Multi-device Review

  1. 1.
    Gravenstein D, Liem EB, Bjoraker DG. Alternative management techniques for the difficult airway: optical stylets. Curr Opin Anaesthesiol. 2004;17(6):495–8.PubMedCrossRefGoogle Scholar


  1. 2.
    Powell L, Andrzejowski J, Taylor R, Turnbull D. Comparison of the performance of four laryngoscopes in a high-fidelity simulator using normal and difficult airway. Br J Anaesth. 2009;103(5):755–60.PubMedCrossRefGoogle Scholar
  2. 3.
    Corbanese U, Possamai C. Awake intubation with the Bonfils fibrescope in patients with difficult airway. Eur J Anaesthesiol. 2009;26(10):837–41.PubMedCrossRefGoogle Scholar
  3. 4.
    Maeyama A, Kodaka M, Miyao H. [BONFILS retromolar intubation fiberscope VS styletscope for oro-tracheal intubation] [Japanese]. Masui. 2009;58(10):1323–7.PubMedGoogle Scholar
  4. 5.
    Piepho T, Noppens RR, Heid F, Werner C, Thierbach AR. Rigid fibrescope Bonfils: use in simulated difficult airway by novices. Scand J Trauma Resusc Emerg Med. 2009;17(1):33.PubMedCrossRefGoogle Scholar
  5. 6.
    Corbanese U, Morossi M. The Bonfils intubation fibrescope: clinical evaluation and consideration of the learning curve. Eur J Anaesthesiol. 2009;26(7):622–4.PubMedCrossRefGoogle Scholar
  6. 7.
    Aucoin S, Vlatten A, Hackmann T. Difficult airway management with the Bonfils fiberscope in a child with Hurler syndrome. Paediatr Anaesth. 2009;19(4):421–2.PubMedCrossRefGoogle Scholar
  7. 8.
    Baker P, Mahadevan M. The Bonfils fiberscope is not suitable for neonatal intubation. Paediatr Anaesth. 2009;19(4):418.PubMedCrossRefGoogle Scholar
  8. 9.
    Bhagwat A, Bhadoria P, Wadhawan S, Gupta L. A novel aid for intubation using the bonfils retromolar scope. Acta Anaesthesiol Scand. 2009;53(3):418–9.PubMedCrossRefGoogle Scholar
  9. 10.
    Xue FS, Luo MP, Liao X, He N. Airway topical anesthesia using the Bonfils fiberscope. J Clin Anesth. 2009;21(2):154–5.PubMedCrossRefGoogle Scholar
  10. 11.
    Sorbello M, Paratore A, Morello G, Merli G, Belluoccio AA, Petrini F. Bonfils fiberscope: better preoxygenate rather than oxygenate! Anesth Analg. 2009;108(1):386.PubMedCrossRefGoogle Scholar
  11. 12.
    He N, Xue FS, Xu YC, Liao X, Xu XZ. Awake orotracheal intubation under airway topical anesthesia using the Bonfils in patients with a predicted difficult airway. Can J Anaesth. 2008;55(12):881–2.PubMedCrossRefGoogle Scholar
  12. 13.
    Bein B, Wortmann F, Meybohm P, Steinfath M, Scholz J, Dörges V. Evaluation of the pediatric Bonfils fiberscope for elective endotracheal intubation. Paediatr Anaesth. 2008;18(11):1040–4.PubMedCrossRefGoogle Scholar
  13. 14.
    Caruselli M, Zannini R, Giretti R, Rocchi G, Camilletti G, Bechi P, et al. Difficult intubation in a small for gestational age newborn by bonfils fiberscope. Paediatr Anaesth. 2008;18(10):990–1.PubMedCrossRefGoogle Scholar
  14. 15.
    Liao X, Xue FS, Zhang YM. Tracheal intubation using the Bonfils intubation fibrescope in patients with a difficult airway. Can J Anaesth. 2008;55(9):655–6; author reply 656–7.Google Scholar
  15. 16.
    Mihai R, Blair E, Kay H, Cook TM. A quantitative review and meta-analysis of performance of non-standard laryngoscopes and rigid fibreoptic intubation aids. Anaesthesia. 2008;63(7):745–60; review.Google Scholar
  16. 17.
    Abramson SI, Holmes AA, Hagberg CA. Awake insertion of the bonfils retromolar intubation fiberscope in five patients with anticipated difficult airways. Anesth Analg. 2008;106(4):1215–7, table of contents.Google Scholar
  17. 18.
    Rudolph C, Henn-Beilharz A, Gottschall R, Wallenborn J, Schaffranietz L. The unanticipated difficult intubation: rigid or flexible endoscope? Minerva Anestesiol. 2007;73(11):567–74.PubMedGoogle Scholar
  18. 19.
    Byhahn C, Meininger D, Walcher F, Hofstetter C, Zwissler B. Prehospital emergency endotracheal intubation using the Bonfils intubation fiberscope. Eur J Emerg Med. 2007;14(1):43–6.PubMedCrossRefGoogle Scholar
  19. 20.
    Buehner U, Oram J, Elliot S, Mallick A, Bodenham A. Bonfils semirigid endoscope for guidance during percutaneous tracheostomy. Anaesthesia. 2006;61(7):665–70.PubMedCrossRefGoogle Scholar
  20. 21.
    Maeyama A, Kodaka M, Koyama K, Okuyama S, Maruo T, Miyao H. [Newly developed BONFILS retromolar intubation fiberscope for difficult airway]. Masui. 2006;55(4):494–8.PubMedGoogle Scholar
  21. 22.
    Rudolph C, Schneider JP, Wallenborn J, Schaffranietz L. Movement of the upper cervical spine during laryngoscopy: a comparison of the Bonfils intubation fibrescope and the Macintosh laryngoscope. Anaesthesia. 2005;60(7):668–72.PubMedCrossRefGoogle Scholar
  22. 23.
    Bein B, Caliebe D, Römer T, Scholz J, Dörges V. Using the Bonfils intubation fiberscope with a double-lumen tracheal tube. Anesthesiology. 2005;102(6):1290–1.PubMedCrossRefGoogle Scholar
  23. 24.
    Maybauer MO, Maier S, Thierbach AR. An unexpected difficult intubation. Bonfils rigid fiberscope. Anaesthesist. 2005;54(1):35–40.PubMedCrossRefGoogle Scholar
  24. 25.
    Bein B, Yan M, Tonner PH, Scholz J, Steinfath M, Dörges V. Tracheal intubation using the Bonfils intubation fibrescope after failed direct laryngoscopy. Anaesthesia. 2004;59(12):1207–9.PubMedCrossRefGoogle Scholar
  25. 26.
    Bein B, Worthmann F, Scholz J, Brinkmann F, Tonner PH, Steinfath M, et al. A comparison of the intubating laryngeal mask airway and the Bonfils intubation fibrescope in patients with predicted difficult airways. Anaesthesia. 2004;59(7):668–74.PubMedCrossRefGoogle Scholar
  26. 27.
    Wong P. Intubation times for using the Bonfils intubation fibrescope. Br J Anaesth. 2003;91(5):757; author reply 757–8.Google Scholar


  1. 28.
    Greenland KB, Liu G, Tan H, Edwards M, Irwin MG. Comparison of the Levitan FPS scope and the single-use bougie for simulated difficult intubation in anaesthetised patients. Anaesthesia. 2007;62(5):509–15. Erratum in: Anaesthesia. 2007;62(6):644.Google Scholar
  2. 29.
    Levitan RM, Chudnofsky C, Sapre N. Emergency airway management in a morbidly obese, noncooperative, rapidly deteriorating patient. Am J Emerg Med. 2006;24(7):894–6.PubMedCrossRefGoogle Scholar
  3. 30.
    Levitan RM. Design rationale and intended use of a short optical stylet for routine fiberoptic augmentation of emergency laryngoscopy. Am J Emerg Med. 2006;24(4):490–5.PubMedCrossRefGoogle Scholar
  4. 31.
    Paladino L, DuCanto J, Manoach S. Development of a rapid, safe, fiber-optic guided, single-incision cricothyrotomy using a large ovine model: a pilot study. Resuscitation. 2009;80(9):1066–9.PubMedCrossRefGoogle Scholar
  5. 32.
    Manoach S, Paladino L. Trauma airway salvage using an optical stylet with oxygen insufflation. J Clin Anesth. 2008;20(4):317–8.PubMedCrossRefGoogle Scholar
  6. 33.
    Kovacs G, Law AJ, Petrie D. Awake fiberoptic intubation using an optical stylet in an anticipated difficult airway. Ann Emerg Med. 2007;49(1):81–3.PubMedCrossRefGoogle Scholar


  1. 34.
    Yao YT, Jia NG, Li CH, Zhang YJ, Yin YQ. Comparison of endotracheal intubation with the Shikani Optical Stylet using the left molar approach and direct laryngoscopy. Chin Med J (Engl). 2008;121(14):1324–7.Google Scholar
  2. 35.
    Stricker P, Fiadjoe JE, McGinnis S. Intubation of an infant with Pierre Robin sequence under dexmedetomidine sedation using the Shikani Optical Stylet. Acta Anaesthesiol Scand. 2008;52(6):866–7.PubMedCrossRefGoogle Scholar
  3. 36.
    Jansen AH, Johnston G. The Shikani Optical Stylet: a useful adjunct to airway management in a neonate with popliteal pterygium syndrome. Paediatr Anaesth. 2008;18(2):188–90.PubMedCrossRefGoogle Scholar
  4. 37.
    Young CF, Vadivelu N. Does the use of a laryngoscope facilitate orotracheal intubation with a Shikani Optical Stylet? Br J Anaesth. 2007;99(2):302–3.PubMedCrossRefGoogle Scholar
  5. 38.
    Young CF, Vadivelu N. Can the Shikani Optical Stylet facilitate intubation in simulated difficult direct laryngoscopy? Conn Med. 2007;71(7):407–8.PubMedGoogle Scholar
  6. 39.
    Turkstra TP, Pelz DM, Shaikh AA, Craen RA. Cervical spine motion: a fluoroscopic comparison of Shikani Optical Stylet vs Macintosh laryngoscope. Can J Anaesth. 2007;54(6):441–7.PubMedCrossRefGoogle Scholar
  7. 40.
    Evans A, Morris S, Petterson J, Hall JE. A comparison of the Seeing Optical Stylet and the gum elastic bougie in simulated difficult tracheal intubation: a manikin study. Anaesthesia. 2006;61(5):478–81.PubMedCrossRefGoogle Scholar
  8. 41.
    Duffy MR, Ingham J. The Seeing Optical Stylet for percutaneous tracheostomy. Anaesthesia. 2006;61(3):298–9.PubMedCrossRefGoogle Scholar
  9. 42.
    Shukry M, Hanson RD, Koveleskie JR, Ramadhyani U. Management of the difficult pediatric airway with Shikani Optical Stylet. Paediatr Anaesth. 2005;15(4):342–5.PubMedCrossRefGoogle Scholar

Manufacturer’s Web Sites

  1. CLARUS MEDICAL: Shikani, Levitan, Video Scope—

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Emergency MedicineThomas Jefferson University HospitalPhiladelphiaUSA

Personalised recommendations