Optical and video stylets for airway management: an expert review

Abstract

Introduction: Optical and video stylets are increasingly important airway management devices that combine real-time visualization with a slim rigid or semi-rigid design. They facilitate tracheal intubation in anatomically constrained airways while minimizing cervical spine movement and mouth-opening requirements.

Areas covered: This narrative review examines the evolution, technical principles, classification, clinical applications, safety profile, and future developments of optical and video stylets. A structured literature search of PubMed/MEDLINE, Embase, and the Cochrane Library was conducted for publications published between January 1990 and January 2026. Randomized controlled trials, observational studies, systematic reviews, meta-analyses, and relevant international guidelines were prioritized.

Expert opinion: Video stylets have progressively replaced optical systems because of superior image quality, ergonomics, and training utility. Their greatest value lies in anatomically constrained airways and as complementary tools within multimodal airway management strategies. Persistent limitations, particularly lack of suction capability and sensitivity to contamination, support their role as adjuncts rather than universal airway devices.