The Role of the Lightwand

  • Ashutosh Wali


The lightwand has been used in airway management for more than five decades and was first described to assist direct laryngoscopic orotracheal intubation in 1957 [1]. Soon after, in 1959, a study reported the successful use of the lightwand, based on the principle of transillumination of the throat, to facilitate nasotracheal intubation in 29 of 30 patients with severe trismus [2]. The authors noted three concerns that are still valid today: the need for a dark room to appreciate transillumination in the neck, the difficulty in transilluminating patients with thick necks, and the risk of thermal injury [2]. The lightwand was first used as a commercial stylet, later that year [3]. However, the initial interest in the device soon waned, probably because of the difficulty in transillumination of the light through red rubber tracheal tubes that were being used at that time. The lightwand regained popularity with the advent of clear, plastic tracheal tubes in 1985. It was reported to be useful in accurately determining the position of tracheal tubes, with 96 % accuracy, in less than 5 s [4] and was used to facilitate difficult tracheal intubation in adults [5]. Currently, many lightwand devices (e.g., Flexilum™, Concept Corporation, Clearwater FL; Surch Lite™, Aaron Medical, Clearwater FL and Tubestat™, Xomed, Jackonville FL) are available from different manufacturers (Fig. 10.1). The Trachlight™ (Laerdal, Wappingers Falls, NY) was the most widely used and studied of these devices (Fig. 10.2); however, the manufacturer discontinued this product in 2009 due to declining sales.


Cervical Spine Tracheal Intubation Tracheal Tube Difficult Airway Direct Laryngoscopy 
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  1. 1.
    Macintosh R, Richards H. Illuminated introducer for endotracheal tubes. Anaesthesia. 1957;12(2):223–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Evans T. Device for Blind Nasal Intubation. 1959;20(2):221.Google Scholar
  3. 3.
    Berman RA. Lighted stylet. Anesthesiology. 1959;20(3):382–3.PubMedGoogle Scholar
  4. 4.
    Stewart RD, LaRosee A, Kaplan RM, Ilkhanipour K. Correct positioning of an endotracheal tube using a flexible lighted stylet. Crit Care Med. 1990;18(1):97–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Olson KW, Culling DC. An alternative use for a nasotracheal tube. Can J Anaesth. 1989;36(2):252–3.PubMedGoogle Scholar
  6. 6.
    Hung OR, Stewart RD. Intubating stylets. In: Hagberg CA, editor. Benumof’s airway management principles and practice. Philadelphia, PA: Mosby Elsevier; 2007. p. 463.Google Scholar
  7. 7.
    Locker GJ, Staudinger T, Knapp S, Burgmann H, Laczika KF, Zimmerl M, et al. Assessment of the proper depth of endotracheal tube placement with the trachlight. J Clin Anesth. 1998;10(5):389–93.PubMedCrossRefGoogle Scholar
  8. 8.
    Hung OR, Stewart RD. Illuminating stylet (lightwand). In: Benumof JL, editor. Airway management principles and practice. St. Louis, Missouri: Mosby-Year Books, Inc.; 1996. p. 342.Google Scholar
  9. 9.
    Kuo YW, Yen MK, Cheng KI, Tang CS, Chau SW, Hou MF, et al. Lightwand-guided endotracheal intubation performed by the nondominant hand is feasible. Kaohsiung J Med Sci. 2007;23(10):504–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Hung OR, Stewart RD. Lightwand intubation: I–a new lightwand device. Can JAnaesth. 1995;42(9):820–5.CrossRefGoogle Scholar
  11. 11.
    Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98(5):1269–77.Google Scholar
  12. 12.
    Hung OR, Pytka S, Morris I, Murphy M, Launcelott G, Stevens S, et al. Clinical trial of a new lightwand device (trachlight) to intubate the trachea. Anesthesiology. 1995;83(3):509–14.PubMedCrossRefGoogle Scholar
  13. 13.
    Hung OR, Pytka S, Morris I, Murphy M, Stewart RD. Lightwand intubation: II–clinical trial of a new lightwand for tracheal intubation in patients with difficult airways. Can J Anaesth. 1995;42(9):826–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Fisher QA, Tunkel DE. Lightwand intubation of infants and children. J Clin Anesth. 1997;9(4):275–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Fan KH, Hung OR, Agro F. A comparative study of tracheal intubation using an intubating laryngeal mask (fastrach) alone or together with a lightwand (trachlight). J Clin Anesth. 2000;12(8):581–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Chan PL, Lee TW, Lam KK, Chan WS. Intubation through intubating laryngeal mask with and without a lightwand: a randomized comparison. Anaesth Intensive Care. 2001;29(3):255–9.PubMedGoogle Scholar
  17. 17.
    Dimitriou V, Voyagis GS, Brimacombe J. Flexible lightwand-guided intubation through the ILM. Acta Anaesthesiol Scand. 2001;45(2):263–4.PubMedGoogle Scholar
  18. 18.
    Addas BM, Howes WJ, Hung OR. Light-guided tracheal puncture for percutaneous tracheostomy. Can J Anaesth. 2000;47(9):919–22.PubMedCrossRefGoogle Scholar
  19. 19.
    Dimitriou V, Voyagis GS, Iatrou C, Brimacombe J. Flexible lightwand-guided intubation using the intubating laryngeal mask airway in the supine, right, and left lateral positions in healthy patients by experienced users. Anesth Analg. 2003;96(3):896–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Hung OR, al-Qatari M. Light-guided retrograde intubation. Can J Anaesth. 1997;44(8):877–82.PubMedCrossRefGoogle Scholar
  21. 21.
    Konishi A, Kikuchi K, Sasui M. Cervival spine movement during light-guided orotracheal intubation with lightwand stylet (trachlight). Masui. 1998;47(1):94–7.PubMedGoogle Scholar
  22. 22.
    Turkstra TP, Craen RA, Pelz DM, Gelb AW. Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope. Anesth Analg. 2005;101(3):910–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Hirabayashi Y, Hiruta M, Kawakami T, Inoue S, Fukuda H, Saitoh K, et al. Effects of lightwand (Trachlight) compared with direct laryngoscopy on circulatory responses to tracheal intubation. Br J Anaesth. 1998;81(2):253–5. Epub 1998/11/14.PubMedCrossRefGoogle Scholar
  24. 24.
    Nishikawa K, Omote K, Kawana S, Namiki A. A comparison of hemodynamic changes after endotracheal intubation by using the lightwand device and the laryngoscope in normotensive and hypertensive patients. Anesth Analg. 2000;90(5):1203–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Nishikawa K, Kawamata M, Namiki A. Lightwand intubation is associated with less hemodynamic changes than fibreoptic intubation in normotensive, but not in hypertensive patients over the age of 60. Can J Anaesth. 2001;48(11):1148–54.PubMedCrossRefGoogle Scholar
  26. 26.
    Montes FR, Giraldo JC, Betancur LA, Rincon JD, Rincon IE, Vanegas MV, et al. Endotracheal intubation with a lightwand or a laryngoscope results in similar hemodynamic variations in patients with coronary artery disease. Can J Anaesth. 2003;50(8):824–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Casati A, Aldegheri G, Fanelli G, Gioia L, Colnaghi E, Magistris L, et al. Lightwand intubation does not reduce the increase in intraocular pressure associated with tracheal intubation. J Clin Anesth. 1999;11(3):216–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Nishiyama T, Matsukawa T, Hanaoka K. Optimal length and angle of a new lightwand device (trachlight). J Clin Anesth. 1999;11(4):332–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Nishiyama T, Matsukawa T, Hanaoka K. Safety of a new lightwand device (trachlight): temperature and histopathological study. Anesth Analg. 1998;87(3):717–8.PubMedGoogle Scholar
  30. 30.
    Hodgson RE, Gopalan PD, Burrows RC, Zuma K. Effect of cricoid pressure on the success of endotracheal intubation with a lightwand. Anesthesiology. 2001;94(2):259–62.PubMedCrossRefGoogle Scholar
  31. 31.
    Nishikawa K, Kawana S, Namiki A. Comparison of the lightwand technique with direct laryngoscopy for awake endotracheal intubation in emergency cases. J Clin Anesth. 2001;13(4):259–63.PubMedCrossRefGoogle Scholar
  32. 32.
    Favaro R, Tordiglione P, Di Lascio F, Colagiovanni D, Esposito G, Quaranta S, et al. Effective nasotracheal intubation using a modified transillumination technique. Can J Anaesth. 2002;49(1):91–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Chen TH, Tsai SK, Lin CJ, Lu CW, Tsai TP, Sun WZ. Does the suggested lightwand bent length fit every patient? The relation between bent length and patient’s thyroid prominence-to-mandibular angle distance. Anesthesiology. 2003;98(5):1070–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Amornyotin S, Sanansilp V, Amorntien V, Tirawat P. Effectiveness of lightwand (trachlight) intubation by 1st year anesthesia residents. J Med Assoc Thai. 2002;85 Suppl 3:S963–8. Journal Article.PubMedGoogle Scholar
  35. 35.
    Cheng KI, Chu KS, Chau SW, Ying SL, Hsu HT, Chang YL, et al. Lightwand-assisted intubation of patients in the lateral decubitus position. Anesth Analg. 2004;99(1):279–83.PubMedCrossRefGoogle Scholar
  36. 36.
    Stone DJ, Stirt JA, Kaplan MJ, McLean WC. A complication of lightwand-guided nasotracheal intubation. Anesthesiology. 1984;61(6):780–1.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Baylor College of MedicineHoustonUSA

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