Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation

Abstract

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