Light-guided tracheal intubation using a prototype illuminated flexible catheter through the intubating laryngeal mask

Abstract

We evaluated the efficacy of a newly developed prototype illuminated flexible catheter to facilitate tracheal intubation through the intubating laryngeal mask and compared this light-guided technique with the conventional blind tracheal intubation through the intubating laryngeal mask. The illuminated flexible catheter consists of a completely flexible thin plastic catheter, a bulb attached to its distal end, a 15-mm concentric adapter at its proximal end connected with a battery and a power switch. The device is placed into a silicone tracheal tube in such a way that the bulb protrudes from the distal end of the tracheal tube. One hundred adult patients, ASA I-III, scheduled to undergo propofol/fentanyl/atracurium anaesthesia for elective surgery were studied. All participants underwent a randomized double comparative cross over trial with respect to the tracheal intubation technique through the intubating laryngeal mask. The light guided tracheal intubation was performed as follows; the tracheal tube preloaded with the illuminated flexible catheter was inserted through the intubating laryngeal mask and by observing the glow in the neck was advanced into the trachea. Whenever resistance was felt during insertion, appropriate adjusting manoeuvres were performed. The intubating laryngeal mask was inserted successfully in all patients. The success rate for the blind and light-guided technique was 91% and 100%, respectively (P = 0.003). The mean (+/- SD) duration including appropriate intubating laryngeal mask placement and tracheal intubation, was significantly lower in the light-guided tracheal intubation technique, than with the blind tracheal intubation (31 +/- 8 s vs. 43 +/- 18 s; P < 0.0001). We conclude that the use of an illuminated flexible catheter carries advantages either in optimizing the intubating laryngeal mask position in the laryngopharynx or in achieving a quick and safe light-guided advancement from laryngopharynx into the trachea.

Light wand guided tracheal intubation through the intubating laryngeal mask

“…These results are in agreement with those reported in a similar randomised, double cross over comparative study [1], using a prototype flexible lightwand (FLW) [2]. However, Kihara et al .…”

Use of the intubating laryngeal mask in children: an evaluation using video-endoscopic monitoring

“…In the three patients with a down folded epiglottis, the visual control of the endotracheal tube tip helped to adapt the intubation procedure instantly, instead of blind probing for the laryngeal inlet. Therefore, the proposed endoscopic monitoring technique converts the primary blind intubation procedure into a safe and atraumatic intubation technique and carries advantages similar to those of an illuminated catheter, recently reported by Dimitrious and Voyagis [16]. This helps to prevent potential complications, such as oesophageal intubation or trauma to the upper airway [7,17].…”

Blind intubation device for nasotracheal intubation in 100 oral and maxillofacial surgery patients with anticipated difficult airways: a prospective evaluation

“…The light-guiding catheter was inserted through the oesophagus airway. The following manoeuvres were applied according to the location of the glow [19]. If the glow was above the laryngeal prominence and in the midline, but the light-guiding catheter could not be moved downward, it indicated that the ventilation hole of the oesophagus airway might be above the glottis.…”

“…We defined each light-guiding catheter insertion after oesophagus airway adjustment as an additional attempt. A bright glow in the midline at the level of the laryngeal prominence and the same disappearing at the level of the suprasternal notch indicated that the light-guiding catheter had passed the glottis and entered into the trachea [19]. Thereafter, the oesophagus airway was withdrawn and removed carefully with the light-guiding catheter still in the trachea.…”