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Lightwand intubation: I — A new lightwand device

Abstract

Tracheal intubation under direct vision using a laryngoscope can be challenging and difficult even in experienced hands. Transillumination of the soft tissues of the neck using a lightedstylet (lightwand) is one of many effective alternative intubating techniques developed during the past several decades. While many versions of lightwand have been available, each has its limitations. A newly developed lightwand (Trachlight™) has incorporated many design modifications. It has a brighter bulb, permitting intubation under ambient light in most cases. A retractable stiff wire within the wand adds flexibility to facilitate both oral and nasal intubation. The flexible wand also allows visual (transillumination) guide to proper placement of the tip of the tracheal tube in the trachea. The Trachlight™ does have some limitations. It is a light-guided technique in which there is no direct visualization of the upper airway structures. It should be avoided in patients with known anatomical abnormalities of the upper airway and used with caution in patients in whom transillumination of the anterior neck may not be achieved adequately. As with any intubating technique, successful intubation using the Trachlight™ relies on the preparation of the patient and the operator’s skill and experience.

Résumé

Même entreprise par des personnes expérimentées, l’intubation sous vision directe avec un laryngoscope peut être laborieuse. La transillumination des tissus du cou avec un mandrin lumineux constitue une des techniques de rechange développées au cours des dernières décennies. Bien que plusieurs versions du mandrin lumineux soient disponibles, elles ont toutes leurs limites. Un nouveau mandrin lumineux (Trachlight™) incorpore plusieurs modifications au design original. L’éclairage est intense, ce qui permet l’intubation à la lumière ambiante dans la plupart des cas. Un stylet rétractile à l’intérieur du mandrin ajoute de la flexibilité ce qui facilite l’intubation orale et nasale. Le mandrin flexible permet aussi de guider visuellement (par transillumination) le bout de la canule endotrachéale dans la trachée. Le Trachlight™ a aussi ses limites. Il s’agit d’une technique d’orientation par la lumière qui ne perm et pas de visualiser directement les structures des voies aériennes supérieures. Elle devrait être évitée dans les cas d’anomalies connue de l’anatomie des voies aériennes supérieures et utilisée avec prudence lorsque la transillumination des structures antérieures du cou ne peut être réalisée correctement. Comme pour toutes les techniques d’intubation, le succès dépend de la préparation du patient, et de l’expérience et de l’habileté de l’intubateur.

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Author information

Correspondence to Orlando Ricardo Hung.

Additional information

Supported, in part, by a Grant from Laerdal Research Foundation, Armonk, NY.

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Hung, O.R., Stewart, R.D. Lightwand intubation: I — A new lightwand device. Can J Anaesth 42, 820–825 (1995). https://doi.org/10.1007/BF03011186

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Key words

  • anaesthetic equipment: Lightwand, lighted-stylet
  • intubation, tracheal: technique, Lightwand