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Canadian Journal of Anesthesia 51:1052-1053 (2004)
© Canadian Anesthesiologists' Society, 2004

Correspondence

Lightwand intubation can improve airway management

Yoshitaka Inoue, MD PhD

Fukuoka, Japan

Support was provided solely from Institutional and/or Departmental sources.

To the Editor:

During the last five years, the author has used a light-guided intubation technique with the TrachlightTM (TL; Laerdal Corporation, New York, NY, USA) as the first-choice device for tracheal intubation in clinical practice, including patients with potential cervical spine instability or predicted difficult laryngoscopy. The results of my experience in 1,500 consecutive intubations with the TL (in epochs of 50 cases) are shown in the FigureGo. The results show a less than 0.5% failure rate with a more than 90% success rate at the first attempt after gaining sufficient experience in the first 500 cases. No serious adverse events related to the procedure were encountered. The results indicate that this simple and inexpensive technique is a valuable adjunct not only in the management of difficult airways but also in daily clinical practice.



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  		FIGURE Success rate at first attempt (full circles) and failed cases (*) of every 50 cases in each epoch.

 
Details of the technique have been described by Agro et al.,1 Graham2 and Davis et al.3 One advantage of the TL over conventional methods is that, even if the epiglottis falls on the posterior pharyngeal wall, the tip of the TL can be placed at the glottic opening when light-guided from the lateral posterior side through the piriform fossa. The TL does not require a space in the pharynx to visualize upper airway structures. Moreover, lightwand intubation does not appear to be influenced by anatomical variations of the upper airway.4 I therefore believe that the technique may be more reliable and safer than conventional laryngoscopy in patients whose upper airway does not need to be visualized because of pathological lesions such as tumours, infections, and trauma.

Furthermore, intubation with the TL seems to be comparable to conventional laryngoscopy with respect to simplicity, ease of use and cost. If lightwand intubation was used regularly and became the first-line option for general anesthesia, the strategies for intubation of the difficult airway as well as the preanesthetic evaluation of the airway would have to change. It is tempting to argue that the more common use of light-guided intubation among anesthesiologists may render routine use of direct laryngoscopy an anachronism and that current airway management strategies might be reassessed.

References

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

2 Graham DH. Lightwand intubation using the Trachlight: a brief review of current knowledge (Letter). Can J Anesth 2001; 48: 1169–70.[Free Full Text]

3 Davis L, Cook-Sather SD, Schreiner MS. Lighted stylet tracheal intubation: a review. Anesth Analg 2000; 90: 745–56.[Free Full Text]

4 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]




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