A Comparison of Hemodynamic Changes After Endotracheal Intubation by Using the Lightwand Device and the Laryngoscope in Normotensive and Hypertensive Patients

Abstract

We compared the effects of the lightwand technique on hemodynamic responses, time-to-intubation, number of attempts, and complications during tracheal intubation with those of direct-vision laryngoscopy in normotensive (LN and TN group; n = 20, respectively) and hypertensive (LH and TH group; n = 20, respectively) patients. Lightwand or laryngoscopic oral endotracheal intubation was performed after the induction of anesthesia with fentanyl and propofol and muscle relaxation with vecuronium. Systolic blood pressure, diastolic blood pressure, and heart rate were recorded, and the change from "before intubation" to "immediately after intubation" (DeltaP) in each variable was calculated. In normotensive patients, significantly larger DeltaP in systolic blood pressure was observed in the LN group than in the TN group (P < 0. 05). In hypertensive patients, there were no significant differences between the LH group and the TH group in DeltaP after intubation. The time-to-intubation and number of attempts in the lightwand groups were significantly longer and more frequent than those in the laryngoscope groups (P < 0.05). The number of patients who complained of hoarseness was larger in the lightwand groups than in the laryngoscope groups (P < 0.05). We conclude that the lightwand technique significantly attenuates hemodynamic changes after intubation in comparison with the laryngoscopic technique in normotensive patients. However, in hypertensive patients, there is no difference in hemodynamic changes between the two techniques.

Use of the fibreoptic stylet scope (Styletscope™) reduces the hemodynamic response to intubation in normotensive and hypertensive patients

“…Similar investigations using a lightwand (Trachlight™, Laerdal Medical, Armonk, NY, USA) technique have been conducted, 9,10 since this method of intubation requires neither elevation of the epiglottis by the laryngoscope blade nor exposure of the glottic opening. However, both Hirabayashi et al 9 and Nishikawa et al 10 found that the circulatory responses to tracheal intubation were similar to those of direct-vision laryngoscopy. Hirabayashi et al 9 used a jaw-lifting technique for lightwand intubation, and they speculated that the magnitude of this stimulus was sufficient to cause a circulatory response.…”

“…Hirabayashi et al 9 used a jaw-lifting technique for lightwand intubation, and they speculated that the magnitude of this stimulus was sufficient to cause a circulatory response. 9 Nishikawa et al 10 required significantly more time for intubation and a greater number of attempts at intubation using the lightwand technique, compared to laryngoscopy. The technique employed in our study required only a short period of time and no jaw lifting for intubation.…”

“…One of the reasons for the reduced frequency of sore throat in the stylet scope group might be the lack of direct stimuli to the mouth and the larynx. Nishikawa et al 10 reported that the number of patients who complained of hoarseness after tracheal intubation using the lightwand technique was greater than that after intubation using direct laryngoscopy. If the tip of the lightwand does not enter the trachea directly, an intense stimulus is applied to the upper airway, 11 which may injure the vocal cords as well as the perilaryngeal tissue.…”

Lightwand intubation is associated with less hemodynamic changes than fibreoptic intubation in normotensive, but not in hypertensive patients over the age of 60

“…[3][4][5] In the present study, we used lightwand-assisted and fibreoptic intu- values are expressed as mean ± SD. MAP=mean arterial pressure; HR=heart rate; RPP=rate-pressure product; F=patients without hypertension (q) and with hypertension (n) itubated with a fibreoptic endoscope; L=patients without hypertension (q) and with hypertension (n) intubated with a lightwand.…”

“…[3][4][5] Fibreoptic endotracheal intubation, which requires neither elevation of the epiglottis nor exposure of the glottis by a laryngoscope blade, requires skill in manipulation of the endoscope. 6 On the other hand, a lighted stylet also enables intubation to be performed without the use of laryngoscope.…”