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Objective To evaluate the efficacy of the flexible laser endotracheal intubation light-wand device in guiding tracheal intubation in pediatric patients. Methods Ninety pediatric patients of both sexes, aged 4-8 yr, of American Society of Anesthesiologists physical statusⅠor Ⅱ, scheduled for elec-tive surgery under general anesthesia requiring oral tracheal intubation, were divided into 2 groups ( n=45 each) using a random number table method: flexible laser endotracheal intubation lightwand device group ( group A) and direct laryngoscope group ( group B) . After induction of anesthesia, orotracheal intubation was carried out with a flexible laser endotracheal intubation lightwand device in group A or with a direct la-ryngoscope in group B. The development of hypertension and tachycardia during intubation, intubation time, and rate of successful intubation were recorded. The development of complications such as sore throat, hoarseness, aphonia and dysphagia was recorded at 24 h after surgery. Results Compared with group B, no significant change was found in the total rate of successful intubation ( P>0. 05) , the rate of successful intubation at first attempt was significantly increased, incubation time was shortened, and the in-cidence of hypertension and tachycardia during intubation and sore throat after surgery was decreased in group A ( P<0. 05) . Conclusion The flexible laser endotracheal intubation lightwand device produces bet-ter efficacy in guiding tracheal intubation when compared with direct laryngoscope in pediatric patients.
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Objective To investigate the effects of angle and length of lightwand in patients with ankylosing spondylitis (AS) using three-dimensional reconstruction based on computed tomography.Methods The head and neck helical computed tomography data of 53 patients with AS(AS group)and 60 common patients without cervical spine deformity (control group) were retrospectively analyzed.Reconstructed images, obtained by three-dimensional computed tomography reconstruction technique, were printed out by the ratio of 1:1.The endotracheal tube was used to simulate tracheal intubation in patient's computed tomography images.The length of tracheal tube from midpoint of glottis to upper central incisor(L),bend angle of tracheal tube(α),distance between the upper central incisor and root of epiglottis (D1) and distance between the root of epiglottis and midpoint of glottis (D2) were recorded.Results The α and D1in AS group were significantly bigger than those in control group:(89.57 ± 15.22)°vs.(67.65 ± 13.32)°and(8.11 ± 0.69)cm vs.(7.39 ± 0.58)cm,and there were statistical differences(P<0.05).There were no statistical differences in L and D2between 2 group(P>0.05).The α, L, D1and D2in male AS patients were significantly bigger than those in female AS patients:(90.78 ± 14.51)° vs.(81.57 ± 15.01)°, (12.84 ± 0.88)cm vs.(11.56 ± 1.17)cm, (8.18 ± 0.59)cm vs.(7.69 ± 0.64)cm and(3.22 ± 0.38)cm vs.(2.30 ± 0.29)cm,and there were statistical differences(P<0.05).Conclusions Compared with that of common patients, the bent angle on lightwand with AS patients is increased,which also can be affected by patients'gender.
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Objective To compare of the application of tracheal intubation guided by Lightwand,Shikani optical stylet,or Macintosh. Methods Ninety ASA Ⅰ~Ⅱ patients undergoing elective general anesthesia were randomly divided into three groups(n = 30):Macintosh group(group M),Lightwand group(group L)and Shi-kani optical stylet group(group S). MAP and HR were recorded at the time of entering the operating room(T1), before intubation(T2),at the immediate time of intubation(T3),3 mins(T4)and 5 mins after intubation(T5). The intubation duration,the first intubation success rate,the number of intubation,and the incidence of complications including sore throat were observed. Results As compared with T1,MAP and HR decreased significantly at T2in the three groups(P<0.05). As compared with T2,HR increased in group L and MAP and HR increased in group S at T3(P<0.05). As compared with group M,MAP and HR at T4and T5were lower in groups L and S(P<0.05). The first intubation time was obviously shorter in group L than in other groups(P<0.05). The incidence of compli-cations was lower in group S(P < 0.05). The first success rate of intubation,the intubation times and the inci-dence of airway complications did not differ significantly among the three groups.(P > 0.05). Conclusions As compared with Macintosh,Lightwand and Shikani optical stylet have less influence on hemodynamic parameters. Lightwand needs shorter intubation time,Shikani optical stylet has the lowest rate of sore throat.
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Objective To investigate the effects of angle and length of lightwand in three-dimensional reconstruction images of the upper airway based on computed tomography.Methods A total of 245 patients,aged 18-86 years,were scanned by helical computed tomography in the head and neck.Reconstructed images,obtained by Aw4.4 Workstation,were printed out by the ratio of 1 ∶ 1.The tracheal tube was used to investigate the anatomic structure of the upper airway.The length L and angle α of the tracheal tube were recorded.And two distances (D1,D2) and one angle (β) were recorded:D1,the distance between the upper central incisor and root of epiglottis;D2,the distance between the root of epiglottis and midpoint of glottis;angle β,the angle of line D1 and D2.Results The oα value in male patients was significant higher than that in female patients:(70.02 ± 15.49)° vs.(55.84 ± 14.70)°.The β value in male patients was significant higher than that in female patients:(129.74 ± 14.82)° vs.(120.40 ± 14.19)°.The L value in male patients was significant higher than that in female patients:(12.80 ± 0.85) cm vs.(11.50 ± 0.65) cm.The D1 and D2value in male patients were significant higher than those in female patients:(7.53 ± 0.66) cm vs.(6.76 ± 0.53) cm,(3.13 ± 0.52) cm vs.(2.45 ± 0.32) cm.There were significant differences (P ＜ 0.05).The 245 patients were classified to 2 groups by using the function of hierarchical cluster analysis in the statistical software.The α value in group 2 was significant higher than that in group 1:(75.45 ± 9.53)° vs.(48.17 ± 9.29)°.The 3 value in group 2 was significant higher than that in group 1:(136.27 ± 9.86)° vs.(112.31 ± 8.64)°.The age in group 2 was significant higher than that in group 1:(53.92 ± 19.64) years vs.(36.93 ± 17.21) years.Correlation analysis showed that in 245 patients,angle α was positively correlated to angle β and age (P ＜ 0.05),and angle β was positively correlated to age (P ＜ 0.05).Conclusions The bent length and angle on lightwand can be affected by both the patients' gender and ages.
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Objective To compare the effect and safety between lightwand and general-laryngo-scope application of trachea cannula in cervical spine fracture patients undergoing general anesthesia. Methods Forty cervical spine fracture patients with tracheal intubation anesthesia were selected,including twenty-eight males and twelve females,aged 18-65 years,ASA physical statusⅡor Ⅲ.These patients were randomly divided into two groups,twenty cases in each group.After anesthesia induction,group L was giv-en general laryngoscope intubation,whereas group C was taken lightwand guided tracheal intubation.The success case of intubation at first,intubation time,adverse reaction of intubation,changes of MAP and HR at intubation and 5 minutes after intubation were observed.Results Compared with group L,success rate of intubation at first was higher (90% vs.60%),intubation time was shorter [(31.3±11.1)s vs.(46.6 ±15.2)s]in group C (P <0.05).The changes of MAP and HR were more stable during intubation in group C compared with group L.Four cases of arrhythmia (20%)occurred in group C,while none in group L.Conclusion Compared with intubation by general laryngoscope,application of tracheal intubation led by lightwand in cervical fracture patients is more effective and safer.
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Objective To compare the effects oflightwand(LW) and direct laryngoscope(DL) in elderly patients undergoing surgery on hemodynamics and stress responses.Methods Forty elderly patients with ASA grade Ⅰ-Ⅱ grade who selective surgery were divided into LW group and DL group by random digits table method,each group with 20 cases.Systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate(HR) were recorded respectively before intubation,30 seconds and 5 minutes after intubation.Extracted patients with peripheral arterial 3 ml at the same time,measured by radioimmunoassay epinephrine and norepinephrine levels.Results The SBP,DBP,HR,epinephrine,norepinephrine 30 seconds after intubation in LW group were significantly lower than those in DL group [(140.50 ± 21.91) mm Hg(1 mm Hg =0.133 kPa) vs.(167.95 ± 17.85) mm Hg,(67.80 ± 6.76) mm Hg vs.(84.15 ±9.89) mm Hg,(85.10 ± 11.76) times/min vs.(96.30 ± 13.72) times/min,(49.47 ± 8.09) ng/L vs.(61.25 ± 9.43) ng/L,(171.27 ± 17.11) ng/L vs.(187.40 ± 16.13) ng/L,P ＜ 0.01].The SBP,epinephrine,norepinephrine 5 minutes after intubation in LW group were significantly lower than those in DL group [(120.75 ± 17.12) mm Hg vs.(136.65 ± 15.43) mm Hg,(39.80 ±7.38) ng/L vs.(47.63 ±8.48) ng/L,(155.93 ± 17.11) ng/L vs.(172.76 ± 13.45) ng/L,P ＜ 0.01].Conclusion Both LW and DL can be well done in elderly patients intubation,but LW can reduce stress responses during the intubation.
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BACKGROUND: Target-controlled infusion (TCI) of propofol and remifentanil can provide satisfactory intubating conditions without a neuromuscular blocking agent. We compared the effect-site concentration of remifentanil required for intubation with the lightwand and the Macintosh laryngoscope during propofol TCI without a neuromuscular blocking agent in adult patients. METHODS: Forty-nine patients were randomly assigned to the lightwand group (n = 25) or the direct laryngoscope group (n = 24). Anesthesia was induced by propofol TCI with an effect-site concentration of 5.4 microg/ml. Two minutes after start of propofol TCI, remifentanil was administered at the predetermined effect-site concentration. The effect-site concentration of remifentanil was determined using Dixon's up-and-down method (0.5 ng/ml as a step size). The first patient in each group was tested at 4.5 ng/ml of remifentanil. Tracheal intubation was performed 2 min after the start of remifentanil TCI. Acceptable intubation was defined as an excellent or good intubating conditions. RESULTS: Using a modified Dixon's up and down method, the EC50 +/- SD of remifentanil in the lightwand and laryngoscope groups was 4.75 +/- 0.71 ng/ml and 5.08 +/- 0.52 ng/ml, respectively; there was no statistically significant difference between the groups (P = 0.373). CONCLUSIONS: The effect-site concentration of remifentanil for acceptable intubation with the lightwand and Macintosh laryngoscope in 50% of adults did not differ during propofol TCI without a neuromuscular blocking agent.
Subject(s)
Adult , Humans , Anesthesia , Intubation , Laryngoscopes , Laryngoscopy , Neuromuscular Blockade , Piperidines , PropofolABSTRACT
Objective To compare the rates of successful intubation between light-stylet and adjustable McCoy laryngoscope for the management of difficult airway with active oral bleeding. Method Thirty casualties traumatized with active oral bleeding were enrolled after failure of endotracheal intubation tried twice by an attending doctor with Macintosh laryngoscope. The patients were randomly( random number) divided into light-stylet (LS)group and McCoy laryngoscope(MC) group ( n = 15 in each group). The rate of successful intubation and the time consumed for intubation were recorded. Results The rate of successful intubation at the first attempt and the total rate of successful intubation in LS group were higher than those in MC group (14/15 vs. 6/15, P =0.005, 15/15 vs. 9/15, P =0.017, respectively). The time consumed for intubation was less in LS group than that in MC group (24 seconds in average,ranged from 23 ～ 34 seconds vs 48 seconds in average, ranged from 31 ～ 119 seconds, P =0.011). Conclusions The light-stylet is a novel tool for intubation in casualties with difficult airway and active oral bleeding with high success rate.
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Electromyogpraphic endotracheal tube (EMG tube) is a new device used to monitor recurrent laryngeal nerve integrity during thyroid surgery. The EMG tube has 2 pairs of electrodes on the surface of silicon-based tube reached to inner space of tube cuff. We experienced an unusual endotracheal tube-related problem from the distinct structural feature of the EMG tube. In this case, we intubated a patient who had difficult airway with the EMG tube using a lightwand. After successful endotracheal intubation, we could not expand the pilot balloon and ventilate the patient effectively. We removed the EMG tube and found that one of electrodes of the EMG tube is bended and made a right angle with the long axis of the tube, and perforated the tube cuff. So we report this case to make anesthesia providers aware that much more attention is needed to use EMG tube during endotracheal intubation.
Subject(s)
Humans , Anesthesia , Axis, Cervical Vertebra , Electrodes , Intubation , Intubation, Intratracheal , Organothiophosphorus Compounds , Recurrent Laryngeal Nerve , Thyroid GlandABSTRACT
BACKGROUND: The aim of this study was to determine the clinical effective dose of rocuronium for tracheal intubation using a lightwand after induction with propofol, alfentanil, and a low concentration of sevoflurane. METHODS: Twenty-eight adults scheduled to undergo elective surgery lasting less than one hour were enrolled in this study. All patients received alfentanil (10 microgram/kg) and propofol (1.5 mg/kg) for the induction of anesthesia. Tracheal intubation using a lightwand was attempted 3 minutes after administering rocuronium and mask ventilation with 2 vol% of sevoflurane. The initial rocuronium dose was 0.5 mg/kg. The rocuronium dose for consecutive patients, determined by Dixon's up-and-down method, was increased or decreased by 0.05 mg/kg according to the result of the previous patient. The mean arterial pressure and heart rate were recorded before induction, 1 min before intubation, 1 and 2 min after intubation. RESULTS: The 50% clinical effective dose (cED(50)) of rocuronium for tracheal intubation using a lightwand was 0.20 +/- 0.05 mg/kg according to Dixon's up and down method. Isotonic regression revealed the cED(50) and cED(95) (95% confidence intervals) to be 0.20 mg/kg (0.10-0.3 mg/kg) and 0.35 mg/kg (0.16-0.49 mg/kg), respectively. CONCLUSIONS: The cED(50) and cED(95) of rocuronium for tracheal intubation using the lightwand were 0.20 mg/kg and 0.35 mg/kg, respectively, after induction with alfentanil, propofol, and a low concentration of sevoflurane.
Subject(s)
Adult , Humans , Alfentanil , Androstanols , Anesthesia , Arterial Pressure , Heart Rate , Intubation , Masks , Methyl Ethers , Propofol , VentilationABSTRACT
BACKGROUND: Airwayscope (AWS), which has been used successfully for difficult airway in general anesthesia, has been anticipated that hemodynamic response to tracheal intubation in the difficult airway may be attenuated. Also, there is a series of reports demonstrating the successful use of lightwand to open the difficult airway. Thus, we decided to conduct a survey to compare AWS to lightwand and to direct laryngoscopy of cardiovascular response to tracheal intubation. METHODS: Of 64 healthy patients without cardiovascular disease, 22, 21, 21 patients were randomly assigned to AWS group, lightwand group and direct laryngoscope group. After induction of general anesthesia, intubation was performed with manual in-line neck stabilization. During laryngoscopy, a modified Cormack-Lehane grade was assessed and time to intubation was measured. Systolic arterial pressure (SAP) and heart rate (HR) were recorded at the following timepoints: baseline, just before intubation, 1 min, 2 min, 3 min, 4 min and 5 min after intubation. RESULTS: There were no significant differences between the 3 groups in SAP, HR (P > 0.05). However modified Cormack-Lehane grade of all patients in the AWS group was I, while that in direct laryngoscope group was IIB or III. In addition, the mean time to intubation of the direct laryngoscope group was significantly longer than that of the AWS and lightwand (P < 0.05). CONCLUSIONS: In the difficult airway, AWS was very effective in improving laryngeal view and decreasing time to intubation compared to direct laryngoscopey. In addition, lightwand reduced the time to intubation. However we could not find any significant difference in hemodynamic response to tracheal intubation among the 3 groups.
Subject(s)
Humans , Anesthesia, General , Arterial Pressure , Cardiovascular Diseases , Heart Rate , Hemodynamics , Intubation , Laryngoscopes , Laryngoscopy , NeckABSTRACT
BACKGROUND: The sniffing position is recommended for optimal glottic visualization under direct laryngoscopy. However, there is no study assessing whether sniffing position is superior to a neutral position during lightwand-guided intubation. This prospective, randomized study was performed to compare facilitation of lightwand-guided intubation between the sniffing and neutral positions. METHODS: The study included 180 patients with normal cervical spines requiring tracheal intubation for elective surgery. Patients were randomly allocated into two groups: neutral or sniffing position. Mallampati class, mouth opening distance, thyromental distance, and laryngeal view grade were measured. A lightwand railroaded with an endotracheal tube was bent 90degrees at 5 cm from the distal end for both groups. Time to intubation, success rate and intubation time for the first attempt, hydrodynamic changes, and BIS values were recorded. RESULTS: There were no significant differences in time to intubation, success rate and intubation time of the first trial, hydrodynamic changes, or BIS values between the two positions. CONCLUSIONS: Routine use of the sniffing position does not provide any advantage over the neutral position during lightwand-guided intubation.
Subject(s)
Humans , Hydrodynamics , Imidazoles , Intubation , Laryngoscopy , Mouth , Nitro Compounds , Prospective Studies , Railroads , SpineABSTRACT
BACKGROUND: Tracheal intubation with a lightwand intubating device (Trachlight) attenuates the hemodynamic stress response to tracheal intubation compared with a direct laryngoscope approach. We compared the effects of the direct laryngoscope (Macintosh blade) and lightwand for intubation in patients with cerebral aneurysm. METHODS: Twenty-four patients undergoing cerebral aneurysm clipping surgery were randomly divided to either the lightwand (Group 1, n = 12) or the laryngoscope (Group 2, n = 12) Group. All patients received fentanyl (2-3microg/kg), midazolam (0.1 mg/kg), and thiopental sodium (2-3microg/kg) followed by vecuronium (0.1- 0.15microg/kg). The lungs were ventilated with 3-4% isoflurane in oxygen, with 1% lidocaine (1-1.5microg/kg) administered before intubation with either the lightwand or the laryngoscope. Systolic, diastolic and mean blood pressures and heart rate were recorded continuously before and for 5 min after intubation. RESULTS: Systolic and mean arterial blood pressure increased significantly (P < 0.05) 1 minute after intubation, but then returned to normal within the next minute. There were no differences in hemodynamic changes between the two groups, and no complications. CONCLUSIONS: Intubation technique did not affect hemodynamic changes in patients with cerebral aneurysm. In patients with aneurysms, appropriate anesthetic levels and pharmacologic manipulation will attenuate the hemodynamic stress response associated with tracheal intubation.
Subject(s)
Humans , Aneurysm , Arterial Pressure , Fentanyl , Heart Rate , Hemodynamics , Intracranial Aneurysm , Intubation , Intubation, Intratracheal , Isoflurane , Laryngoscopes , Lidocaine , Lung , Midazolam , Oxygen , Thiopental , Vecuronium BromideABSTRACT
BACKGROUND: Several methods have been attempted to enhance the success rate of tracheal intubation using a lightwand. Some studies have reported that changing the shape of a lightwand and the position of the head during intubation could influence the intubation time or success rate. However, there are no reports concerning the head position of a patient on influencing the success rate during tracheal intubation using a lightwand. METHODS: We enrolled 109 ASA physical status I and II patients scheduled for elective surgery under general anesthesia. Patients were randomly allocated to the sniffing group (n = 52) or neutral group (n = 57), depending on the head position. A lightwand (Surch-Lite(TM), Bovie/Aaron Medical, St. Petersburg, USA) was bent at 9.5 cm from the distal tip with a 0 cm extrusion for both groups of patients (J shape). The head was elevated by approximately 8 cm in the sniffing group of patients and by approximately 2 cm in the neutral group of patients, with the face straight up maintained by placement of a pillow. RESULTS: The overall success rate at the first attempt was 98.1%. There were no differences in the mean intubation time between the two groups (sniffing group; 8.0 +/- 4.3 sec and neutral group; 9.3 +/- 4.1 sec). The mean intubation time tended to be longer in patients with modified Mallampati classification III than in patients with modified Mallampati classification I and II. CONCLUSIONS: This study has demonstrated that the use of a J shaped lightwand did not affect the intubation time, regardless of the head position. The intubation time appears to be related to the airway condition when using a lightwand for tracheal intubation.
Subject(s)
Humans , Anesthesia, General , Head , IntubationABSTRACT
We experienced a case of incidental removal of granuloma of vocal cord after blind endotracheal intubation with lightwand. The patient was a 43-years-old female suffering from hoarseness for 2 months and diagnosed as vocal cord pyogenic granuloma developed after primary closure of thyroid cartilage laceration. She had a limited neck extension suggesting difficult intubation, so endotracheal intubation with lightwand was planned to secure airway. After endotracheal intubation using lightwand, the lesion of vocal cord could not be seen in the microscopic exam. We discovered and immediately removed the granuloma on the carina level using rigid bronchoscope.
Subject(s)
Female , Humans , Bronchoscopes , Granuloma , Granuloma, Pyogenic , Hoarseness , Intubation , Intubation, Intratracheal , Lacerations , Neck , Thyroid Cartilage , Vocal CordsABSTRACT
BACKGROUND: The intensity of stimulation of intubation was expressed as the product of its force and duration. Theoretically, use of a lightwand might cause less adrenergic stimulation because the elevation of the epiglottis by the laryngoscope blade was not required. However, whether the hemodynamic responses to intubation with the lightwand differ from those with direct laryngoscope was a controversial topic. Additionally, there has been no clear study showing that the hemodynamic response to intubation is affected by intubation time. This study was designed to analyze the relationship between the magnitude of hemodynamic responses and the intubation time. METHODS: 50 ASA class 1, 2 elective surgical patients were randomly allocated into two groups; lightwand or direct laryngoscope group. Anesthesia was induced by a standardized technique. The changes in MAP and HR were recorded just before intubation, after intubation and 1 minute after intubation. Also the intubation time was recorded. RESULTS: There were no differences in MAP, HR, and intubation time between the groups. The following was the final regression equation from multiple linear regression analysis:the degrees of blood pressure elevation = + 11.2239 (P = 0.0296) + 6.6331 (P = 0.0846) x (group) + 1.0400 (P = 0.0004) x (intubation time). Adjusted R2 is 0.84 (P<0.05). CONCLUSIONS: There was a linear relation between the degree of blood pressure elevation and intubation time in direct laryngoscope group and lightwand group.
Subject(s)
Humans , Anesthesia , Blood Pressure , Epiglottis , Hemodynamics , Intubation , Intubation, Intratracheal , Laryngoscopes , Linear ModelsABSTRACT
BACKGROUND: It has been recommended that lightwand tracheal intubation be used for cases in which there is difficult airway management. Transillumination of the soft tissue of the neck by the lightwand can lead to successful intubation; however, this depends on skin color, obesity, head position, angle and the bent length of the lightwand. The goal of this study was to compare the success rates of intubation on the first attempt and complications of lightwand orotracheal intubation that occurred when using the lightwand at angles of 60 degrees and 90 degrees. METHODS: One hundred forty eight patients of ASA physical status 1 or 2 were enrolled in this study. Patients in whom intubation had previously been difficult as well as patients who had the potential for difficult intubation were excluded from this study. Patients were randomly assigned to one of two groups: The lightwand bent in 60 degrees (LW60) group and the lightwand bent in 90degrees (LW90) group. Anesthesia was performed using propofol (2 mg/kg), fentanyl (1microg/kg) and rocuronium (0.9 mg/kg), and lightwand orotracheal intubation was attempted 2 minutes after the induction of anesthesia. The success rates of intubation, the number of attempts and their duration, as well as hemodynamic changes, resistance to the tube and complications that occurred during the procedure were recorded. RESULTS: In the LW90 group, resistance to the tube during lightwand intubation occurred in a significant number of patients (P < 0.05), however, there were no significant differences observed between the two groups with regard to the intubation success rates on the first attempt, the duration of intubation, hemodynamic changes and complications. CONCLUSIONS: Their were no significant differences observed between intubation success rates on first attempt and complications when using a lightwand bent to 60 degrees or 90 degrees in patients without any previously known airway abnormalities.
Subject(s)
Humans , Airway Management , Anesthesia , Fentanyl , Head , Hemodynamics , Intubation , Neck , Obesity , Propofol , Skin , TransilluminationABSTRACT
BACKGROUND: It has been known that a patient head in sniffing position for lightwand facilitated tracheal intubation is not an anatomically appropriate method. However, there is no evidence nor study whether it is true or not. In this study, we compared success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position. METHODS: With informed consent, sixty adult patients of ASA physical status I or II were randomly allocated into two groups: neutral position (N) or sniffing position (S) group. A lightwand and tube were bent at approximately a 90degrees degree angle for N group and a 60 degree angle for S group on the basis of mouth axis and pharyngeal axis. The time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications during the procedure were recorded. RESULTS: There was no significant difference in the time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications between neutral position and sniffing position groups. CONCLUSIONS: Success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position showed no significant difference. Therefore, both positions are suitable for lightwand assisted intubation.
Subject(s)
Adult , Humans , Axis, Cervical Vertebra , Head , Hemodynamics , Informed Consent , Intubation , MouthABSTRACT
BACKGROUND: It has been known that a patient head in sniffing position for lightwand facilitated tracheal intubation is not an anatomically appropriate method. However, there is no evidence nor study whether it is true or not. In this study, we compared success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position. METHODS: With informed consent, sixty adult patients of ASA physical status I or II were randomly allocated into two groups: neutral position (N) or sniffing position (S) group. A lightwand and tube were bent at approximately a 90degrees degree angle for N group and a 60 degree angle for S group on the basis of mouth axis and pharyngeal axis. The time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications during the procedure were recorded. RESULTS: There was no significant difference in the time to intubation, success rates of 1st trial of intubation, overall intubation success rates, hemodynamic changes and complications between neutral position and sniffing position groups. CONCLUSIONS: Success rates of lightwand facilitated tracheal intubation in neutral position versus sniffing position showed no significant difference. Therefore, both positions are suitable for lightwand assisted intubation.
Subject(s)
Adult , Humans , Axis, Cervical Vertebra , Head , Hemodynamics , Informed Consent , Intubation , MouthABSTRACT
BACKGROUND: Tracheal intubation commonly results in sympathetic stimulation manifested by increased heart rate and arterial blood pressure. This study was carried out to determine whether lightwand would result in less hemodynamic changes than direct laryngoscopy. METHODS: With informed consent, fourty healthy female patients scheduled of elective surgical procedures were randomly allocated into two groups; lightwand (LW) or direct laryngoscopy (DL) group. Mean arterial pressure (MAP) and heart rate (HR) were recorded upon arrival. Under a standardized anesthetic technique, the patients were intubated either with no. 3 curved blade direct laryngoscopy (DL group) or with lightwand (LW group). The MAP and HR were recorded before intubation and every 1 minutes following intubaion. Time to intubation (TTI) was also recorded. All patients were intubated by a same fourth grade resident. RESULTS: Fourty patients were studied. Every intubation was successed in first attempt. The TTI was significantly shorter in LW group. Even while there was no significant difference in HR changes, there was significant difference in the increase of MAP following intubation. The increase of MAP was significantly greater with DL than with LW. CONCLUSIONS: This study suggests that lightwand intubation requires shorter TTI and may give rise to less blood pressure change than direct laryngoscopy. So we found no difference in disadvantage and may offers advantage in terms of hemodynamic stability.