Clinical Comparison of Lightwand-guided versus Conventional Endotracheal Intubation
Keywords:
Anaesthetic techniques, laryngoscopy, lightwand, Intubation, tracheal, TransilluminationAbstract
Background: The lightwand technique has been suggested to be as efficient as direct laryngoscopy for endotracheal intubation, but there are no recent clinical comparisons. This prospective randomised clinical study was designed to evaluate these two techniques in patients undergoing elective surgery.
Methods: The study comprises 194 American Society of Anesthesiologists level I-II patients. Anatomical upper airway conditions were assessed with respect to mouth opening, classification according to Mallampati (I-IV) and neck mobility. Classification according to Cormack-Lehane (I-IV) was made by direct laryngoscopy after the induction of anaesthesia prior to randomisation for intubation (two attempts allowed) guided by either lightwand (TrachlightÔ, Laerdal, Norway) or direct laryngoscopy. The total time and number of attempts required for successful intubation by skilled anaesthesiologists with little experience from the lightwand technique were recorded together with possible associated technical or medical problems.
Results: Intubation guided by lightwand was successful within two attempts in 78 %, whereas the corresponding success rate of direct laryngoscopy was 100 % (P<0.001), also including 21 intubations made after two failed attempts with lightwand. The time for successful intubation by lightwand, 41 (25th percentile 27, 75th percentile 62; range 15–191) s, was significantly (P<0.001) longer than by direct laryngoscopy, 19 (15, 27; 7–180) s. Medical problems possibly associated with lightwand-guided intubation were found in 6 % compared to in 2 % on intubation by direct laryngoscopy (P=0.152).
Conclusions:Â Endotracheal intubation guided by lightwand is slower and less successful than intubation by direct laryngoscopy and does not seem suitable for routine use in clinical anaesthesiology.
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References
Langeron O, Amour J, Vivien B, Aubrun F, Clinical review: Management of difficult airways, Critical Care, vol. 10, pp. 243-244, 2006.
Agro F, Hung OR, Cataldo R, Carassiti M, Gherardi S, Lightwand intubation using the Trachlight: a brief review of current knowledge, Can J Anaesth, vol. 48, pp. 592-599, 2001.
Soh CR, Kong CF, Kong CS, Ip-Yam PC, Chin E, Goh MH, Tracheal intubation by novice staff: the direct vision laryngoscope or the lighted stylet (Trachlight)? Emerg Med J, vol. 19, pp. 292-294, 2002.
Wik L, Naess AC, Steen PA, Intubation with laryngoscope vs. transillumination performed by paramedic students on manikins and cadavers, Resuscitation, vol. 33, pp. 215-218, 1997.
Lipp M, de Rossi L, Daubländer M, Tierbach A, The transillumination technique. An alternative to conventional intubation? Anaesthetist, vol. 45, pp. 923-930, 1996.
Masso E, Sabaté S, Hinojosa M, Vila P, Canet J, Langeron O, Lightwand tracheal intubation with and without muscle relaxation, Anesthesiology, vol. 104, pp. 249-254, 2006.
Hung OR, Pytka S, Stewart RD et al., Clinical trial of a new lightwand device (Trachlight) to intubate the trachea, Anesthesiology, vol. 83, pp. 509-514, 1995.
Amornyotin S, Sanansilp V, Amorntien V, Tirawat P, Effectiveness of lightwand (Trachlight) intubation by 1st year anesthesia residents, J Med Assoc Thai, vol. 85 (Suppl 3), pp. S963-8, 2002.
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