Lightwand intubation of infants and children

Quentin A. Fisher, David E Tunkel

Research output: Contribution to journalArticle

Abstract

Study Objective: To examine factors contributing to successful lightwand (lighted stylet) intubation of infants and children. Design: Prospective observational study. Setting: University hospital. Patients: 125 children under age 10 years presenting for elective surgery. Interventions: Prototype lightwands specifically designed for pediatric patients were used. Intubations were done by anesthesia residents with little or no prior lightwand experience. All attempts were recorded on videotape. In a subgroup of 14 patients, an endoscopic view of the lightwand was also recorded with a flexible nasopharyngoscope. Measurements and Main Results: 125 patients with a mean age of 3.0 years (±2.4 years SD; range: 3 weeks to 9 years) were enrolled. 83.2% were intubated using the lightwand, including 75.5% (34 of 45) of infants weighing less than 10 kg. Of the 21 failed intubations, 8 were due to an inappropriately large endotracheal tube, as recognized during direct laryngoscopy; 4 were due to other reasons discussed; and 9 (persistent vallecular or esophageal entry) could not be explained from videotape analysis. Factors contributing to successful intubation included: (1) use of a shoulder roll and slight head extension; (2) conscientious alignment of airway axes; (3) anterior jaw lift to elevate the epiglottis and (4) gentle handling of the lightwand to avoid displacing soft tissue. Inability to advance the lightwand despite correct glow is caused by entrapment in the vallecula, hang up of the lightwand on the aryepiglottic folds, subglottic narrowing, or vocal cord closure. Conclusions: Lightwand intubation in children uses both tactile and visual cues regarding the location of the endotracheal tube tip. Attention to detail results in a high level of success among novice users of the pediatric lightwand. Endoscopic and external videotaping gave us a means of monitoring the progress of mechanical skills among novice users.

Original languageEnglish (US)
Pages (from-to)275-279
Number of pages5
JournalJournal of Clinical Anesthesia
Volume9
Issue number4
DOIs
StatePublished - Jun 1997

Fingerprint

Intubation
Videotape Recording
Pediatrics
Epiglottis
Laryngoscopy
Vocal Cords
Touch
Jaw
Observational Studies
Cues
Anesthesia
Head
Prospective Studies

Keywords

  • Intratracheal
  • Intubation
  • Lighted
  • Lightwand
  • Neonatology
  • Pediatric
  • Stylet

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Lightwand intubation of infants and children. / Fisher, Quentin A.; Tunkel, David E.

In: Journal of Clinical Anesthesia, Vol. 9, No. 4, 06.1997, p. 275-279.

Research output: Contribution to journalArticle

Fisher, Quentin A. ; Tunkel, David E. / Lightwand intubation of infants and children. In: Journal of Clinical Anesthesia. 1997 ; Vol. 9, No. 4. pp. 275-279.
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