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Lightwand intubation using the Trachlight: a brief review of current knowledge¹

Vancouver, British Columbia

To the Editor:

I enjoyed reading the review by Agrò et al. concerning intubation with the Trachlight^TM lighted stylet.¹ The Halifax group deserves great credit for designing and popularizing this instrument.

I believe the lighted stylet is the method of choice for elective intubations and is often the best solution for various types of difficult intubations. As a result of 12 years experience with lighted stylets,² I would suggest to your readers that they try an alternative technique for intubation with the Trachlight^TM.

I teach my students to use the same ‘sniffing’ position as they would with a laryngoscope. The tube is introduced from the right corner of the mouth with the tongue out of the way to the left. There is no need to put a hand into the patient's mouth. When learning the technique and for difficult cases a darkened room can be very helpful.

We use about a 75° bend at the tip of the tube. The handle of the Trachlight^TM is held like a dart or a cigar. If the tube doesn’t fall into place, one of three gentle manoeuvers may be required. If the light is in a pyriform fossa, the handle is rolled between thumb and fingers which sweeps the light sideways in front of the larynx until it shines brightly through the cords. If the light is in the esophagus, the tube is withdrawn slowly while keeping the tip pushed forward. It will then pop through the cords. Occasionally, a gentle forward thrust by an assistant on the angles of the jaw will be helpful.

Advancing the tube and withdrawing the stylet in one motion saves time. This is analogous to advancing an iv cannula and withdrawing the needle in one motion.

I encourage everyone to try both methods. Some will prefer the Halifax method and others the Vancouver method.

References

1 Agrò F, Hung OR, Cataldo R, Carassiti M, Gherardi S. Lightwand intubation using the Trachlight: a brief review of current knowledge. Can J Anesth 2001; 48: 592–9.[Abstract/Free Full Text]

2 Graham DH, Doll WA, Robinson AD, Warriner CB Intubation with lighted stylet (Letter). Can J Anaesth 1991; 38: 261–2.[Medline]

Rome, Italy

We thank Dr. Graham for his interest in our paper entitled "Lightwand intubation using the Trachlight: a brief review of current knowledge".¹ We are delighted in acknowledging Dr. Graham's clinical experience regarding an alternative technique for intubation with the Trachlight^TM (TL). During the last few years, many studies have confirmed the usefulness of the TL as a semi-blind and easy to use technique for tracheal intubation in case of difficult laryngoscopy.^2–4

Notwithstanding Dr. Graham's suggestions, we investigated a combined technique (direct laryngoscopy and TL) for patients in whom a Cormack grade 3 laryngoscopic view was simulated. We will submit the results of our study for publication in the near future. We noticed that the probability of successful tracheal intubation using the combined technique (direct laryngoscopy and TL) is higher than when direct laryngoscopy or TL are used separately.

A multicentre study to evaluate the efficacy of the Trachlight^TM in difficult tracheal intubations is warranted.

References

1 Agrò F. Hung OR, Cataldo R, Carassiti M, Gherardi S. Lightwand intubation using the Trachlight: a brief review of current knowledge. Can J Anesth 2001; 48: 592–9.

2 Hung OR, Pytka S, Morris I, Murphy M, Stewart RD. Lightwand intubation: II–Clinical trial of a new ligthwand for tracheal intubation in patients with difficult airways. Can J Anaesth 1995; 42: 826–30.[Abstract/Free Full Text]

3 Hung OR, Pytka S, Morris I, et al. Clinical trial of a new lightwand device (Trachlight) to intubate the trachea. Anesthesiology 1995; 83: 509–14.[Medline]

4 Agrò F, Brimacombe J, Marchionni L, Carassiti M, Cataldo R. Nasal intubation with the Trachlight Can J Anesth 1999; 46: 907–8.

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