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Canadian Journal of Anesthesia 49:1000-1001 (2002)
© Canadian Anesthesiologists' Society, 2002

Correspondence

The lightwand: a useful aid in the difficult tracheostomy

Felice Agrò, MD, Fabrizio Salvinelli, MD, Stefano Gherardi, MD and Manuele Casale, MD

Rome, Italy

To the Editor:

Although open, percutaneous and translaryngeal tracheostomy techniques are available, open tracheostomy (OT) remains the most familiar technique at many institutions and still maintains its relevance, particularly where new methods are contraindicated.1 It is usually considered a safe procedure with a complication rate ranging from 6% to 66%.2 This percentage could be higher in the following conditions: morbid obesity, a short and "thick" neck and cervical stiffness.3 In these patients and in any case of difficulty in performing OT, we suggest that the Trachlight (TL; TrachlightTM, Laerdal Medical Corp., NY, USA)4 could be helpful. We successfully used the TL during a difficult OT in a patient affected by respiratory distress operated under local anesthesia. Because of the short and thick neck and cervical stiffness, it was very difficult for the surgeon to identify the trachea. During the procedure tracheal intubation was needed. Under TL guidance, tracheostomy was carried out easily, without complications.

Light-guided tracheostomy (LT) could minimize the risk of damaging the endotracheal tube or the cuff.5 We believe that LT may help tracheal identification in patients with difficult surgical anatomy, a useful and quick procedure to assist surgeons.

In summary, we think the lightwand may be useful, especially in selected difficult cases. We are carrying out a clinical trial in order to evaluate and compare LT and standard open tracheostomy.

References

1 Byhahn C, Lischke V, Westphal K. Translaryngeal tracheostomy in highly unstable patients. Anaesthesia 2000; 55: 678–82[Medline]

2 Friedman Y, Fildes J, Mizock B, et al. Comparison of percutaneous and surgical tracheostomies. Chest 1996; 110: 480–5.[Abstract/Free Full Text]

3 Dubin J. Tracheotomia. In: Elsevier (Ed.). Encyclopédie Médico-Chirurgicale. Tecniche chirurgiche. Chirurgia ORL e cervicofacciale. Paris, France. 1995: 46–430.

4 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]

5 Addas BM, Howes WJ, Hung OR. Light-guided tracheal puncture for percutaneous tracheostomy. Can J Anesth 2000; 47: 919–22[Abstract/Free Full Text]





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