A Comparison Between the Conventional and the Laryngoscope-Assisted Lightwand Intubation Techniques in Patients With Cervical Immobilization: A Prospective Randomized Study

Kim, Eugene; Kim, Byung Gun; Lim, Young Jin; Jeon, Young Tae; Hwang, Jung Won; Lee, Seo Yun; Park, Hee Pyoung

doi:10.1213/ane.0000000000001661

Cited by 5 publications

(7 citation statements)

References 27 publications

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“…Compared with previous studies of cervical-immobilized patients showing initial intubation success rates of 63%, 75%, or 87% using the lightwand, [17][18][19] our study showed a similar or slightly lower success rate on the first attempt (64%) in the single lightwand group. In our study, intubation was performed by first-or secondgrade residents under intense conditions of limited mouth opening due to application of a fitted neck collar combined with performance of manual in-line stabilization techniques.…”

Section: Discussioncontrasting

confidence: 48%

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Comparison between use of single lightwand and video laryngoscope-guided lightwand for tracheal intubation in simulated cervical spine-immobilized patients: a single-blind randomized study

Kim

Yoon

et al. 2019

J Int Med Res

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ObjectiveThis study was performed to compare the use of a video laryngoscope-guided lightwand versus a single lightwand for tracheal intubation performed by non-experts in cervical spine-immobilized patients.MethodsIn total, 318 patients under general anesthesia were assigned either to the single lightwand group (Group L) or the video laryngoscope-guided lightwand group (Group VL) at a 1:1 ratio. First- or second-grade residents performed tracheal intubation with the assigned device after applying semi-hard fitted cervical collars to the patients. Outcomes, including the success rate and airway complications, were compared between the two groups.ResultsThere were no significant differences in demographics or airway-related characteristics between the two groups. The success rate of intubation on the first attempt was significantly higher in Group VL than in Group L (90% vs. 64%, respectively). Postoperative complications, including oral mucosal bleeding, hoarseness, and sore throat scores at 1 and 24 hours after surgery, were significantly lower in Group VL than in Group L.ConclusionsThe use of a video laryngoscope-guided lightwand for tracheal intubation can be useful for non-experts who encounter difficult airway situations.

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Section: Discussioncontrasting

confidence: 48%

“…Kim et al. 19 recently performed a study of similar design to compare conventional lightwand intubation and direct laryngoscope-assisted lightwand intubation in patients with cervical immobilization. Their study showed an 89% success rate on the first attempt with lightwand-assisted direct laryngoscopy.…”

Section: Discussionmentioning

confidence: 99%

Comparison between use of single lightwand and video laryngoscope-guided lightwand for tracheal intubation in simulated cervical spine-immobilized patients: a single-blind randomized study

Kim

Yoon

et al. 2019

J Int Med Res

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“…Three trials were judged to be at low risk of bias, 13 at unclear risk and 2 at high risk . Random sequence generation was assessed as low risk of bias in 16 trials, allocation concealment in 9 trials, completeness of outcome data in 8 trials, selective outcome reporting in 4 trials and other bias in 15 trials (Figure and Figure , Table ).…”

Section: Resultsmentioning

confidence: 99%

“…In the remaining 14 RCTs, [12][13][14][18][19][20][21][22][23][24][25][26]28,29 intubation was performed under general anesthesia after administration of sedative and neuromuscular blocking agents. Since the evaluated techniques were highly heterogeneous, we decided to perform two main meta-analytic comparisons focused on the devices commonly available in the operating room: (a) direct, traditional Macintosh laryngoscopy versus other techniques (three RCTs; Figure 2) and (b) videolaryngoscopy versus other techniques (five RCTs; Figure 3).…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

Tracheal intubation in patients at risk for cervical spinal cord injury: A systematic review

Cabrini

Redaelli

Filippini

et al. 2019

Acta Anaesthesiol Scand

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Background: Tracheal intubation in patients at risk for secondary spinal cord injury is potentially difficult and risky. Objectives: To compare tracheal intubation techniques in adult patients at risk for secondary cervical spinal cord injury undergoing surgery. Primary outcome was firstattempt failure rate. Secondary outcomes were time to successful intubation and procedure complications. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA). Data Sources: Databases searched up to July 2019. Eligibility: Randomized controlled trials comparing different intubation techniques. Results: We included 18 trials enrolling 1972 patients. Four studies used the "awake" approach, but no study compared awake versus non-awake techniques. In remaining 14 RCTs, intubation was performed under general anesthesia. First-attempt failure rate was similar when comparing direct laryngoscopy or fiberoptic bronchoscopy versus other techniques. A better first-attempt failure rate was found with videolaryngoscopy and when pooling all the fiberoptic techniques together. All these results appeared not significant at TSA, suggesting inconclusive evidence. Intubating lighted stylet allowed faster intubation. Postoperative neurological complications were 0.34% (no significant difference among techniques). No life-threatening adverse event was reported; mild local complications were common (19.5%). The certainty of evidence was low to very low mainly due to high imprecision and indirectness. Conclusions: Videolaryngoscopy and fiberoptic-assisted techniques might be associated with higher first-attempt failure rate over controls. However, low to very low certainty of evidence does not allow firm conclusions on the best tracheal intubation in patients at risk for cervical spinal cord injury.

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“…Lightwand intubation does not require anterior displacement of the tongue and epiglottis. Kim et al reported that laryngoscopeassisted lightwand intubation resulted in a higher incidence of successful intubation on the first attempt than intubation with only a lightwand, by improving the maintenance of midline alignment in the hypopharynx and allowing free movement of the lightwand in the oral cavity (15). A difficult airway is defined as a clinical situation in which anticipated or unanticipated difficulty or failure is experienced by a physician trained in anesthesia care due to difficult face mask ventilation (inadequate mask seal, excessive gas leak, or excessive resistance to the ingress or egress of gas), difficult laryngoscopy (not possible to visualize any portion of the vocal cords after multiple attempts at laryngoscopy), difficult supraglottic airway ventilation, difficult or failed tracheal intubation and extubation, and inadequate ventilation (3).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation

HONG,

LEE,

HWANG

et al. 2023

In Vivo

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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/m 2 was correlated with the weak group. Conclusion: BMI ≥24.6 kg/m 2 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.Successful intubation is of great importance for airway management during general anesthesia. Although intubation techniques and tools have rapidly developed, the lightwand, which has long been used in airway management, still has benefits. Lightwand intubation is a technique in which a lightbulb stylet is introduced into the endotracheal tube and the tube tip is directed into the trachea by transillumination through the anterior neck tissue (1). The lightwand has been recommended for difficult airway management by the American Society of Anesthesiologists (ASA) (2). When mask ventilation is adequate, but intubation is unsuccessful, alternative noninvasive approaches can be attempted using a lightwand, laryngeal mask airway, or different laryngoscope blades (nonemergency pathways) (1, 2). In 2022, the ASA updated their recommendations concerning the suggested equipment for the management of difficult airways (3). In particular, they suggested non-invasive and invasive alternatives by emphasizing awareness of the passage of time and limiting the number of attempts using different devices and techniques (3). Non-invasive devices include lighted or optical stylets, videolaryngoscopes, flexible intubation scopes, and adjuncts (3). In anticipated difficult airway management, if a noninvasive approach is selected, they recommend identifying a preferred sequence of non-invasive devices (3). The lightwand is easy to carry and prepare, inexpensive, and easy for physicians to learn (4). A lightwand can be a valuable disposable intubation tool for difficult intubation (5), particularly during the COVID-19 pandemic. After the 490

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A Comparison Between the Conventional and the Laryngoscope-Assisted Lightwand Intubation Techniques in Patients With Cervical Immobilization: A Prospective Randomized Study

Abstract: Laryngoscope-assisted lightwand intubation did not increase intubation time, and it increased first attempt intubation rates compared with traditional lightwand intubation in patients requiring cervical immobilization for cervical spine surgery.

Cited by 5 publications

References 27 publications

Comparison between use of single lightwand and video laryngoscope-guided lightwand for tracheal intubation in simulated cervical spine-immobilized patients: a single-blind randomized study

Comparison between use of single lightwand and video laryngoscope-guided lightwand for tracheal intubation in simulated cervical spine-immobilized patients: a single-blind randomized study

Tracheal intubation in patients at risk for cervical spinal cord injury: A systematic review

Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation

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