Face-to-face intubation using a lightwand in a patient with severe thoracolumbar kyphosis: a case report.

BACKGROUND: Severe deformity of the thoracolumbar spine may cause difficulty in airway management during induction of anesthesia. Therefore, special attention must be devoted to patient safety. CASE PRESENTATION: A 65-year-old male with severe thoracolumbar kyphosis was scheduled to undergo posterior spinal fusion under general anesthesia. Due to his inability to lie supine, conventional tracheal intubation under direct laryngoscopy was difficult. Alternatively, face-to-face tracheal intubation using a lightwand in the semi-recumbent position was performed. Intubation was successful on the first attempt without any complications. CONCLUSIONS: The face-to-face intubation technique using a lightwand is one of several alternative techniques for tracheal intubation in patients who cannot lie supine.

A comparison of single-handed chin lift and two-handed jaw thrust for tracheal intubation using a lightwand.

PURPOSE: In the present study, we evaluated the effects of single-handed chin lift and two-handed jaw thrust on lightwand-guided intubation and postoperative sore throat. METHODS: Sixty adult patients were included in the study. After induction of anesthesia, intubation was performed using a lightwand under single-handed chin lift or two-handed jaw thrust. In the single-handed chin lift group, the lightwand was inserted with the right hand after the mandible was lifted by placing the thumb of the left hand into the mouth. In the two-handed jaw thrust group, the lightwand was inserted while jaw thrust was achieved by an assistant using two hands. Lightwand search time, number of intubation attempts, and time to achieve intubation were assessed. Heart rate and mean arterial pressure were measured before and after intubation. Postoperative sore throat was evaluated at 1 and 24 h after surgery. RESULTS: Lightwand search time was significantly shorter in the two-handed jaw thrust group compared to the single-handed chin lift group (7.2 ± 4.6 vs. 12.1 ± 9.1 s, respectively; p = 0.016). The two-handed jaw thrust group had shorter intubation time than the single-handed chin lift group (21.0 ± 6.6 vs. 27.9 ± 9.9 s, respectively; p = 0.004). The number of intubation attempts and hemodynamic changes during intubation were similar between the two groups. The incidence and severity of postoperative sore throat were lower at 24 h after surgery in the two-handed jaw thrust group compared with the single-handed chin lift group (p = 0.011). CONCLUSIONS: The two-handed jaw thrust facilitated lightwand-guided intubation, and reduced the incidence and severity of postoperative sore throat compared to the single-handed chin lift.

A prospective randomised study of a rigid video-stylet vs. conventional lightwand intubation in cervical spine-immobilised patients.

Compared with a lightwand which is used blind, Optiscope™ , a rigid video-stylet, can provide direct imaging of airway structures, potentially offering improved conditions in cervical spine-immobilised patients. We randomly assigned 168 patients who required cervical immobilisation during tracheal intubation to use of the Optiscope or the lightwand. The initial intubation success rate (95% CI) was 90 (82-95)% with the Optiscope and 87 (78-93)% with the lightwand (p = 0.626). Median (IQR [range]) intubation time was longer (19 (12-41 [5-195] s vs. 15 (8-29 [3-117] s; p = 0.016), and there were fewer scooping movements (1 (1-2 [0-9]) vs. 2 (1-3 [0-14]); p = 0.002) when using the Optiscope compared with the lightwand. The incidence of postoperative airway complications was similar in the two groups. The devices were equivalent with respect to initial intubation success rate but the Optiscope yielded slightly longer intubating times.

Appropriate head position for nasotracheal intubation by using lightwand device (Trachlight).

The purpose of this study was to determine the relationship between the head position and the subsequent ease of nasotracheal intubation by using the lightwand device Trachlight (TL). Patients requiring nasotracheal intubation were subdivided into 3 groups according to the intubated head position (group S: sniffing position; group E: extension position; and group N: neutral position). The number of attempts, the total intubation time, and the failures of the TL intubation were recorded. Intubation difficulty by means of TL was assessed by the ordinal 6-point scale. Of the 300 patients enrolled in the study, TL intubation was successful in 91.3% of them. There was no significant difference in the success rate of the first attempt between the groups. No correlation between the ordinal scale and the head position was observed. The total intubation time and the ratio of "unsuccessful" cases were not significantly different among the 3 groups. TL is an effective alternative for patients who require nasotracheal intubation. Our study did not determine the most favorable head position for nasotracheal intubation with the TL, so we recommend that nasotracheal intubation with TL be started with the head in the neutral position and then changed to a more appropriate position, if necessary, on an individual basis.

Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation.

BACKGROUND/AIM: A lightwand is a stylet with a light bulb at its tip that can be used to guide intubation by confirming the illumination through the anterior neck. We aimed to determine the factors affecting the illumination intensity during lightwand endotracheal intubation. PATIENTS AND METHODS: We retrospectively collected data from 180 patients who underwent lightwand endotracheal intubation. We recorded illumination intensity on a 5-point scale. The patients were categorized into weak (score <3) and bright (score ≥3) groups based on the illumination intensity scale score. RESULTS: A total of 176 patients were analyzed, of whom 125 (71.1%) were enrolled in the bright group, and 51 (29.0%) were enrolled in the weak group. Multivariable logistic regression analysis revealed that an increased body mass index (BMI) and mask ventilation grade were associated with light intensity. For mask ventilation, moderate vs. easy (p=0.010) and difficult vs. easy (p=0.008) were associated with the weak group. Receiver operating characteristic curve analysis showed that BMI ≥24.6 kg/m2 was correlated with the weak group. CONCLUSION: BMI ≥24.6 kg/m2 or mask ventilation grade above moderate indicates increased odds of weak illumination intensity in lightwand intubation. Pre-intubation examination of these factors helps increase the chances of successful intubation.

Evaluation of lightwand-guided endotracheal intubation for patients with missing or no teeth: a randomized controlled study.

BACKGROUND: Unhealthy teeth can seriously affect general health and increase the risk of death in elderly people. There has been no confirmation of which device is most effective for elderly patients with teeth loss. Therefore, we compared four intubation devices in elderly patients with partial and total tooth loss aiming to reduce risk during anesthesia. METHODS: Two hundred patients were randomized to undergo tracheal intubation with the Macintosh laryngoscope, the Glidescope, the Fiberoptic bronchoscope or the Lightwand as part of general anesthesia. A unified protocol of anesthetic medications was used. HR and BP were measured at T0, T1, T2, T3, T4 and T5. Catecholamine (epinephrine and norepinephrine) blood samples were drawn at T0, T1 and T2. Intubation time and postoperative complications, including dental damage and losses, were recorded. RESULTS: Reduced fluctuations in HR, DBP, and SBP were observed in the Lightwand group. Intubation time was significantly shorter in the Lightwand group (p < 0.05). There was no statistically significant difference between the groups in epinephrine levels, but norepinephrine levels were less volatile in the Fiberoptic bronchoscope and Lightwand groups. Fewer patients in the Lightwand group experienced dental damage and other postoperative complications than in the other three groups. Although a higher success rate on the first attempt was as high as in the Fiberoptic bronchoscope group, shorter intubation time was observed only in the Lightwand group. CONCLUSION: The Lightwand offers less hemodynamic stimulation than the Macintosh laryngoscope, Glidescope, and Fiberoptic bronchoscope. Because it had the shortest intubation time, the Lightwand caused the least damage to the teeth and throat of elderly patients. Our findings showed that tracheal intubation with the Lightwand was advantageous for preventing cardiovascular stress responses with short intubation times and fewer postoperative complications.

Evaluation of transmitted glow point at a priori chosen depth (1 cm below vocal cords) for lightwand intubation: a prospective observational study.

OBJECTIVE: When performing lightwand intubation, an improper transmitted glow position before tube advancement can cause intubation failure or laryngeal injury. This study was performed to explore the transmitted glow point corresponding to a priori chosen depth for lightwand intubation. METHODS: Before lightwand intubation, we marked the transmitted glow point from a bronchoscope on the neck when it reached 1 cm below the vocal cords. Lightwand intubation was then performed using this marking point. The distances from the mark to the upper border of the thyroid cartilage, upper border of the cricoid cartilage, and suprasternal notch were measured. RESULTS: In total, 107 patients were enrolled. The success rate of lightwand intubation using the mark was 93.5% (95% confidence interval, 88.7%-99.2%) at the first attempt. The marking point was placed 12.0 mm (95% confidence interval, 10.6-13.4 mm) below the upper border of the cricoid cartilage. CONCLUSION: Anaesthesiologists should be aware of the appropriate point of the transmitted glow on the patient's neck when performing lightwand intubation. We suggest that this point is approximately 1 cm below the upper border of the cricoid cartilage.Trial registration: ClinicalTrials.gov NCT03480035.

Dosing study of esmolol for reducing hemodynamic changes during lightwand intubation.

BACKGROUND: Lightwand is a convenient tool that can be used instead of a laryngoscope for intubation. Tracheal intubation causes direct stimulation of the larynx, drastically increasing hemodynamic values including blood pressure and heart rate. This study aims to identify the effect of different doses of esmolol on hemodynamic changes during lightwand intubation. METHODS: The study subjects included 140 patients who underwent general anesthesia for elective surgery. The patients were randomly divided into four groups (35 patients in each group). The 'C' group only received 20 ml of normal saline, while the 'E0.5', 'E1', and 'E2' groups received 20 ml of normal saline containing esmolol-0.5 mg/kg, 1 mg/kg, and 2 mg/kg, respectively, injected 2 min prior to intubation. The patients' blood pressure, heart rate, and rate-pressure product were measured six times, before and after the intubation. RESULTS: The degree of heart rate elevation was suppressed in the E1 and E2 groups compared to the C group, and RPP after intubation significantly decreased in the E2 group compared to the C group. CONCLUSIONS: Esmolol injection, 1-2 mg/kg, prior to lightwand intubation effectively blunts heart rate elevation, and 2 mg/kg of esmolol injection blunts rate-pressure product elevation.

The Effect of Flexible Lightwand and Ultrasonography Combination on Complications of the Percutaneous Dilatational Tracheostomy Procedure.

The aim of this study was to evaluate the effect of the flexible lightwand and ultrasonography (USG) combination on reducing the complications in percutaneous dilatational tracheostomy (PDT) opened with the forceps dilatation method. A retrospective examination was made of 138 patients between January 2014 and December 2018. Before starting to process, the anatomic structures of the patients were visualized with USG and the tracheostomy area was marked. Sedation and local anesthesia were applied to patients before the procedure, then the percutaneous tracheostomy was performed using the Griggs technique after confirmation of the tracheostomy localization defined with USG using the transillumination method with a flexible lightwand within an endotracheal tube. Complications that developed associated with the procedure were recorded. The mean age of the patients was 59.1±22.0 years and the mean length of stay in the intensive care unit was 42.3±35.5 days (range, 11-207 days). Overall, complications developed in 22 (15.6%) patients, of which 10.7% were early complications (1.4% related to the tube, 5.8% minor and 3.5% major complications). Tube- related complications were seen to develop in two patients. In the evaluation of the early minor complications, the most frequently seen complication was minor bleeding in 5.8% of the patients. No major vessel bleeding was determined in any patient in the early or late period. Of the late complications, the infection was seen to develop in four (2.8%) patients and stenosis in three (2.1%). The combination of flexible lightwand and USG in the PDT procedure minimized tube-related complications and contributed to the prevention of bleeding complications.

Application of a flexible lightwand in percutaneous dilatational tracheotomy.

PURPOSE: By comparing flexible lightwand-assisted and conventional endotracheal tube (ETT) withdrawal in percutaneous dilatational tracheotomy (PDT), this paper aims to provide guidance for precise ETT withdrawal by anesthesiologists and accurate determination of the incision site by surgeons. METHODS: Sixty patients who underwent PDT in our hospital were randomly divided into the lightwand group (Group L, n=30) and the withdrawal group (Group W, n=30) using the envelope method. For Group L patients, a flexible lightwand was inserted into an ETT (based on the patient's size), the light source was positioned at the root of the cuff, and the depth from the root of the cuff to the end of the ETT was marked. The flexible lightwand was inserted into the patient's ETT to the marked depth. The ETT along with the flexible lightwand was withdrawn until the highlighted spot was located at the level of the thyroid cartilage. The incision site was approximately 3 finger widths (approximately 4.8cm) below the highlighted spot. For Group W patients, the ETT was withdrawn to a tube depth of 17cm at the upper incisors in males and 15cm in females, and surgeons determined incision sites without assistance. The following metrics were recorded for the two groups: occurrences of inadvertent extubation, ETT puncture and cuff rupture; success rate of first puncture; hypoxia rate; SpO2 at the time of tracheostomy cannula intubation (T1); and postoperative hemorrhage rate. RESULTS: Inadvertent extubation, ETT puncture and cuff rupture occurred significantly less frequently in Group L than in Group W, and the success rate of first puncture and SpO2 at T1 were markedly higher in Group L than in Group W. Moreover, significant between-group differences in hypoxia rate and postoperative hemorrhage rate were observed. CONCLUSIONS: The use of a flexible lightwand in PDT is a safe and effective approach. This approach can effectively and directly guide precise ETT repositioning and provide incision site confirmation with few intra- and postoperative anesthesia-related or operative complications compared with the traditional technique of ETT withdrawal to a pre-determined depth.

A comparison of classic laryngeal mask airway insertion between lightwand- and standard index finger-guided techniques.

STUDY OBJECTIVE: To compare the efficacy of lightwand-guided classic laryngeal mask airway (cLMA) real-time insertion technique with the standard recommended index finger-guided insertion technique. DESIGN: Prospective, randomized controlled study. SETTING: University-affiliated hospital. PATIENTS: Three hundred patients undergoing minor gynecological or orthopedic surgeries under general anesthesia using the cLMA as an airway management tool. INTERVENTIONS: Patients were randomly divided into either lightwand-guided group or standard group. MEASUREMENTS: Fiberoptic bronchoscopy was used to determine the cLMA position after a cLMA was inserted. The first attempt and total success rates of the cLMA insertion, insertion time, distances from the end of cLMA pilot tube to the upper central incisors, views of fiberoptic bronchoscopy, blood staining, tidal volume, airway pressure, end-tidal CO2, SpO2, noninvasive hemodynamic parameters, and others were compared. MAIN RESULTS: The cLMA was all successfully inserted within 3 attempts except for 2 patients in the standard group. The success rates of lightwand-guided insertion technique at first attempt were significantly higher than standard insertion technique; the ideal view rates assessed by fiberoptic bronchoscopy in lightwand-guided group patients were also significantly higher than in standard group patients, but the insertion time of first successful attempt was similar; the blood staining rates on the cLMA in lightwand-guided group patients were significantly less than in standard group patients. The depths of cLMA insertion in standard group patients were significantly deeper than those in lightwand-guided group patients. There was no significant difference in end-tidal CO2, SpO2, airway pressure, and hemodynamic variables. CONCLUSION: Lightwand-guided cLMA insertion technique can provide a more objective indicator for correct cLMA positioning, higher first attempt success rates, better glottic views, and less damage to oropharyngeal or esophagus tissues than standard index finger-guided cLMA insertion technique.

King Vision video laryngoscope versus Lightwand as an intubating device in adult patients with Mallampatti grade III and IV patients.

STUDY OBJECTIVE: Anticipated and unanticipated difficult airways are often encountered by anesthesiologists in their clinical practice. There are various devices available in such situations. We aim to compare King Vision video laryngoscope and Lightwand for their performance as an intubating device in predicted difficult intubation. DESIGN: Prospective, randomized, single blind study. SETTING: Jawaharlal Nehru Medical College. PATIENTS: Sixty ASA 1 and 2 with Mallampati grade III and IV. INTERVENTIONS: Patients were divided into 2 groups of 30 patients each. Patients of King Vision group [n=30] and Lightwand group [n=30] were intubated using respective devices. Primary outcome measure was time taken to intubate whereas secondary outcome measure ware number of attempts for intubation, no of adjustment maneuvers, changes in heart rate and mean arterial pressure and airway trauma. MEASUREMENTS AND MAIN RESULTS: Mean intubation time using King Vision video laryngoscope (19.50±6.73 seconds was lower than the intubation time using Lightwand 25.40±7.42 s, P=.00). The difference between number of attempts, success of intubation, numbers of adjustment maneuvers were comparable. There was a significant rise in heart rate within the groups from the pre-induction values. However inter group variations were similar. In addition, there was a significant rise in mean arterial pressure within the groups from the pre-induction values. Inter group variations show less increase in mean arterial pressure with Lightwand at immediate post intubation (P=.0234) and at 3 min and 5 min post intubation anesthesia.

Efficacy of flexible laser endotracheal intubation lightwand device in guiding endotracheal intubation in pediatric patients / 中华麻醉学杂志

Objective To evaluate the efficacy of the flexible laser endotracheal intubation light-wand device in guiding tracheal intubation in pediatric patients. Methods Ninety pediatric patients of both sexes, aged 4-8 yr, of American Society of Anesthesiologists physical statusⅠor Ⅱ, scheduled for elec-tive surgery under general anesthesia requiring oral tracheal intubation, were divided into 2 groups ( n=45 each) using a random number table method: flexible laser endotracheal intubation lightwand device group ( group A) and direct laryngoscope group ( group B) . After induction of anesthesia, orotracheal intubation was carried out with a flexible laser endotracheal intubation lightwand device in group A or with a direct la-ryngoscope in group B. The development of hypertension and tachycardia during intubation, intubation time, and rate of successful intubation were recorded. The development of complications such as sore throat, hoarseness, aphonia and dysphagia was recorded at 24 h after surgery. Results Compared with group B, no significant change was found in the total rate of successful intubation ( P>0. 05) , the rate of successful intubation at first attempt was significantly increased, incubation time was shortened, and the in-cidence of hypertension and tachycardia during intubation and sore throat after surgery was decreased in group A ( P<0. 05) . Conclusion The flexible laser endotracheal intubation lightwand device produces bet-ter efficacy in guiding tracheal intubation when compared with direct laryngoscope in pediatric patients.

Lightwand-guided nasotracheal intubation in oromaxillofacial surgery patients with anticipated difficult airways: a comparison with blind nasal intubation.

In oromaxillofacial surgery patients, the incidence of difficult airways is up to 15.4-16.9%. Blind nasal intubation remains a safe technique for difficult airway management in some remote areas where a fibreoptic bronchoscope is not always available. The lightwand is an easy-to-use, highly economical device, and can facilitate endotracheal intubation through illumination in the neck. The study aims to evaluate the efficacy of nasotracheal intubation using lightwand in oromaxillofacial surgery patients with difficult airways. One hundred and sixteen patients with difficult airways requiring nasotracheal intubation were randomly divided into a lightwand group and a blind group, with 58 cases in each group. The first attempt and overall success rates of lightwand intubation were 84.5% and 93.1%, respectively, which were higher than those of blind intubation (65.5% and 75.9%, respectively; P<0.05). The total intubation time was 91.4±27.7s in the lightwand group and 130.7±33.4s in the blind group (P<0.001). Patients in the lightwand group also experienced more stable haemodynamic responses and less pharyngalgia. In conclusion, lightwand-guided nasotracheal intubation is superior to blind intubation in patients with difficult airways, with a higher success rate, more stable haemodynamic responses, and fewer postoperative complications.

A comparison of tracheal intubation guided by Lightwand,Shikani optical stylet or Macintosh / 实用医学杂志

Objective To compare of the application of tracheal intubation guided by Lightwand,Shikani optical stylet,or Macintosh. Methods Ninety ASA Ⅰ~Ⅱ patients undergoing elective general anesthesia were randomly divided into three groups(n = 30):Macintosh group(group M),Lightwand group(group L)and Shi-kani optical stylet group(group S). MAP and HR were recorded at the time of entering the operating room(T1), before intubation(T2),at the immediate time of intubation(T3),3 mins(T4)and 5 mins after intubation(T5). The intubation duration,the first intubation success rate,the number of intubation,and the incidence of complications including sore throat were observed. Results As compared with T1,MAP and HR decreased significantly at T2in the three groups(P<0.05). As compared with T2,HR increased in group L and MAP and HR increased in group S at T3(P<0.05). As compared with group M,MAP and HR at T4and T5were lower in groups L and S(P<0.05). The first intubation time was obviously shorter in group L than in other groups(P<0.05). The incidence of compli-cations was lower in group S(P < 0.05). The first success rate of intubation,the intubation times and the inci-dence of airway complications did not differ significantly among the three groups.(P > 0.05). Conclusions As compared with Macintosh,Lightwand and Shikani optical stylet have less influence on hemodynamic parameters. Lightwand needs shorter intubation time,Shikani optical stylet has the lowest rate of sore throat.

A simulation study on the features of the angle and bent length of lightwand for intubation in patients with ankylosing spondylitis / 中国医师进修杂志

Objective To investigate the effects of angle and length of lightwand in patients with ankylosing spondylitis (AS) using three-dimensional reconstruction based on computed tomography.Methods The head and neck helical computed tomography data of 53 patients with AS(AS group)and 60 common patients without cervical spine deformity (control group) were retrospectively analyzed.Reconstructed images, obtained by three-dimensional computed tomography reconstruction technique, were printed out by the ratio of 1:1.The endotracheal tube was used to simulate tracheal intubation in patient's computed tomography images.The length of tracheal tube from midpoint of glottis to upper central incisor(L),bend angle of tracheal tube(α),distance between the upper central incisor and root of epiglottis (D1) and distance between the root of epiglottis and midpoint of glottis (D2) were recorded.Results The α and D1in AS group were significantly bigger than those in control group:(89.57 ± 15.22)°vs.(67.65 ± 13.32)°and(8.11 ± 0.69)cm vs.(7.39 ± 0.58)cm,and there were statistical differences(P<0.05).There were no statistical differences in L and D2between 2 group(P>0.05).The α, L, D1and D2in male AS patients were significantly bigger than those in female AS patients:(90.78 ± 14.51)° vs.(81.57 ± 15.01)°, (12.84 ± 0.88)cm vs.(11.56 ± 1.17)cm, (8.18 ± 0.59)cm vs.(7.69 ± 0.64)cm and(3.22 ± 0.38)cm vs.(2.30 ± 0.29)cm,and there were statistical differences(P<0.05).Conclusions Compared with that of common patients, the bent angle on lightwand with AS patients is increased,which also can be affected by patients'gender.

A simulation study on the effects of the bent length and angle of lightwand: based on the upper airway on computed tomography images / 中国医师进修杂志

Objective To investigate the effects of angle and length of lightwand in three-dimensional reconstruction images of the upper airway based on computed tomography.Methods A total of 245 patients,aged 18-86 years,were scanned by helical computed tomography in the head and neck.Reconstructed images,obtained by Aw4.4 Workstation,were printed out by the ratio of 1 ∶ 1.The tracheal tube was used to investigate the anatomic structure of the upper airway.The length L and angle α of the tracheal tube were recorded.And two distances (D1,D2) and one angle (β) were recorded:D1,the distance between the upper central incisor and root of epiglottis;D2,the distance between the root of epiglottis and midpoint of glottis;angle β,the angle of line D1 and D2.Results The oα value in male patients was significant higher than that in female patients:(70.02 ± 15.49)° vs.(55.84 ± 14.70)°.The β value in male patients was significant higher than that in female patients:(129.74 ± 14.82)° vs.(120.40 ± 14.19)°.The L value in male patients was significant higher than that in female patients:(12.80 ± 0.85) cm vs.(11.50 ± 0.65) cm.The D1 and D2value in male patients were significant higher than those in female patients:(7.53 ± 0.66) cm vs.(6.76 ± 0.53) cm,(3.13 ± 0.52) cm vs.(2.45 ± 0.32) cm.There were significant differences (P ＜ 0.05).The 245 patients were classified to 2 groups by using the function of hierarchical cluster analysis in the statistical software.The α value in group 2 was significant higher than that in group 1:(75.45 ± 9.53)° vs.(48.17 ± 9.29)°.The 3 value in group 2 was significant higher than that in group 1:(136.27 ± 9.86)° vs.(112.31 ± 8.64)°.The age in group 2 was significant higher than that in group 1:(53.92 ± 19.64) years vs.(36.93 ± 17.21) years.Correlation analysis showed that in 245 patients,angle α was positively correlated to angle β and age (P ＜ 0.05),and angle β was positively correlated to age (P ＜ 0.05).Conclusions The bent length and angle on lightwand can be affected by both the patients' gender and ages.