Lightwand-guided nasotracheal intubation in oromaxillofacial surgery patients

The recent article by Dong and colleagues, comparing lightwand-guided and blind nasotracheal intubations in oromaxillofacial surgery patients with anticipated difficult airways, was of great interest. The study showed that lightwand-guided nasotracheal intubation was superior to blind intubation, with a higher success rate, more stable haemodynamic responses, and fewer postoperative complications. Despite these favourable results, we noted that a lightwand with a stiff stylet (Jerome Medical, Shanghai, China) was used for the nasotracheal intubation in that study. Furthermore, the total intubation time in the lightwand group was up to 91.4 ± 27.7 s, which is significantly longer than times reported in previous studies. .

Growing experience in the use of the technique of lightwand-guided nasotracheal intubation has revealed some limitations with the available stiff lighted stylet devices : (1) A weak light intensity that requires the room lights to be dimmed during intubation. (2) The short length of the lighted stylet, which restricts its use to only a single-curve tracheal tube for nasotracheal intubation, as described in the cited study. In fact, double-curve tracheal tubes, such as Ring–Adair–Elwyn tracheal tubes, are commonly required for oromaxillofacial surgery patients to improve the surgical field. (3) The rigidity of the stylet, which hampers the use of these devices for nasotracheal intubation. (4) It is difficult to move a lightwand with a stiff stylet in and out of the tracheal tubes easily once in position.

To address the above shortcomings of the lightwand devices with a stiff stylet, a novel lightwand device – the Trachlight™ (Laerdal Medical Corporation, New York, USA) – was designed specifically for intubation and was introduced in 1995. It incorporates an improved light source and a more flexible wand portion. This added flexibility broadens the utility of the device for both orotracheal and nasotracheal intubations. Thus, the use of a Trachlight is generally recommended for nasotracheal intubation. In a search of the available literature published before 6 November 2013 in PubMed, we noted that since 1995 the lightwand-guided nasotracheal intubation of patients with normal and difficult airways, in the awake state or under anaesthesia, had most frequently been performed with the Trachlight™. Using the Trachlight, Cheng et al. showed that the first attempt and overall success rates of lightwand-guided nasotracheal intubation were 96.7% and 100%, respectively. Also, the total intubation time by lightwand-guided nasotracheal intubation was significantly shorter than that of laryngoscopic nasotracheal intubation (22.8 ± 8.0 s vs. 30.3 ± 8.2 s; P < 0.001).

According to the available literature, the main advantages of the Trachlight™ in nasotracheal intubation include : (1) The length of the soft wand – at 35 cm this allows the use of a double-curve tracheal tube. (2) Removal of the internal wire stylet of the lighted stylet prior to insertion of the Trachlight™ into the tracheal tube can make the assembled tube – Trachlight™ pliable enough for nasotracheal intubation. (3) By cuff inflation of the tracheal tube, the tip of the assembled tube – Trachlight™ can easily be directed into the glottic opening. (4) The soft wand moves easily in and out of the double-curve tracheal tube.



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Jan 19, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Lightwand-guided nasotracheal intubation in oromaxillofacial surgery patients
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