CLINICAL-TRIAL OF A NEW LIGHTWAND DEVICE (TRACHLIGHT) TO INTUBATE THETRACHEA

Background: Transillumination of the soft tissue of the neck using a l ighted stylet (lightwand) is an effective and safe intubating techniqu e. A newly designed lightwand (Trachlight) incorporates modifications to improve the brightness of the light source as well as flexibility. The goal of this study was to determine the effectiveness and safety o f this device in intubating the trachea of elective surgical patients. Methods: Healthy surgical patients were studied. Patients with known or potential problems with intubation were excluded. During general an esthesia, the tracheas were intubated randomly using either the Trachl ight or the laryngoscope. Failure to intubate was defined as lack of s uccessful intubation after three attempts. The duration of each attemp t was recorded as the time from insertion of the device into the oroph arynx to the time of its removal. The total time to intubation (TTI), an overall measure of the ease of intubation, was defined as the sum o f the durations of all (as many as three) intubation attempts. Complic ations, such as mucosal bleeding, lacerations, dental injury, and sore throat, were recorded. Results: Nine hundred fifty patients (479 in t he Trachlight group and 471 in the laryngoscope group) were studied. T here was a 1% failure tate with the Trachlight, and 92% of intubations were successful on the first attempt, compared with a 3% failure rate and an 89% success rate on the first attempt with the laryngoscope (P not significant). All failures were followed by successful intubation using the alternate device. The TTI was significantly less with the T rachlight compared with the laryngoscope (15.7 +/- 10.8 vs. 19.6 +/- 2 3.7 s). For laryngoscopic intubation, the TTI was longer for patients with limited mandibular protrusion and mentohyoid distance, with a lar ger circumference of the neck, and with a high classification accordin g to Mallampatti et al. However, there was no relation between the TTI and any of the airway parameters for Trachlight. There were significa ntly fewer traumatic events in the Trachlight group than in the laryng oscope group (10 vs. 37). More patients complained of sore throat in t he laryngoscope group than in the Trachlight group (25.3% us. 17.1%). Conclucsions: In contrast to laryngoscopy, the ease of intubation usin g the Trachlight does not appear to be influenced by anatomic variatio ns of the upper airway. Intubation occasionally failed with the Trachl ight but in all cases was resolved with direct laryngoscopy. The failu res of direct laryngoscopy were resolved with Trachlight. Thus the com bined technique was 100% successful in intubating the tracheas of all patients.