LIGHTWAND INTUBATION .2. CLINICAL-TRIAL OF A NEW LIGHTWAND FOR TRACHEAL INTUBATION IN PATIENTS WITH DIFFICULT AIRWAYS

Lightwands have been used to assist in the tracheal intubation of pati ents with difficult airways for many years. A new light-wand (Trachlig ht(TM)) with a brighter light source and a flexible stylet permits bot h oral and nasal intubation under ambient light. This study reports th e effectiveness of the Trachlight(TM) in tracheal intubation in patien ts with difficult airways, Two groups of patients were studied: Group 1 - patients with a documented history of difficult intubation or anti cipated difficult airways; Group 2 - anaesthetized patients with an un anticipated failed laryngoscopic intubation. In Group 1, the tracheas were intubated using the Trachlight(TM) with patients either awake or under general anaesthesia. In Group 2, tracheas were intubated under g eneral anaesthesia using the Trachlight(TM). The time-to-intubation, n umber of attempts, failures, and complications during intubation for a ll patients were recorded. Two hundred and sixty-five patients were st udied with 206 patients in Group 1, and 59 in Group 2. In most patient s, the tracheas were intubated orally (183 versus 23 nasal) during gen eral anaesthesia (202 versus 4 awake) in Group 1. Intubation was succe ssful in all but two of the patients with a mean (+/-SD) time-to-intub ation of 25.7 +/- 20.1 sec (range 4 to 120 sec). The tracheas of these two patients were intubated successfully using a fibreoptic bronchosc ope. Orotracheal intubation was successful in all patients in Group 2 using the Trachlight(TM) with a mean (+/-SD) time-to-intubation of 19. 7 +/- 13.5 sec. Apart from minor mucosal bleeding (mostly from nasal i ntubation), no serious complications were observed in any of the study patients. With proper preparation this study has demonstrated that Tr achlight(TM) is an effective and safe device to intubate the tracheas of elective surgical patients with a history of difficult airway in ex perienced hands.