Relevance of radiological and clinical measurements in predicting difficult intubation using light wand (Surch-lite™) in adult patients

Abstract

ObjectiveTo determine the correlation between anatomical features of the upper airway (evaluated via computed tomography imaging) and the ease of light wand-assisted endotracheal intubation in patients undergoing ear, nose and throat surgery under general anaesthesia.MethodsMallampati class, laryngoscopic grade, thyromental distance, neck circumference, body mass index, mouth opening and upper lip bite class were assessed. Epiglottis length and angle, tongue size and narrowest pharyngeal distance were determined using computed tomography imaging. Intubation success rate, time to successful intubation (intubating time) and postoperative throat symptoms were documented.ResultsOf 152 patients, 148 (97.4%) were successfully intubated on the first attempt (mean intubating time 11.5 ± 6.7 s). Intubating time was positively correlated with laryngoscopic grade and body mass index in both male and female patients, and Mallampati class and neck circumference in male patients. Epiglottis length was positively correlated with intubating time.ConclusionsEase of intubation was influenced by epiglottis length. Radiological evaluation may be useful for preoperative assessment of patients undergoing endotracheal intubation with light wand.

Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation

“…A high Mallampati class and BMI ≥30 kg/m 2 interfered with the ease and success of lightwand intubation, because adequate transillumination could not be easily achieved (4). A long epiglottis prolongs intubation time with a lightwand by preventing free advancement of the tube into the trachea even with jaw lift (20). In our study, increased BMI was correlated with the weak group because of inadequate light passage through the neck tissue.…”

No radiographic index predicts difficult intubation using the Optiscope™ in cervical spine surgery patients: a retrospective study

“…Lightwand devices also resemble the Optiscope™ in terms of their shape and manipulation type, although they cannot visualize a patient's larynx during intubation. Previous studies demonstrated that BMI, the Mallampati score, neck circumference, and epiglottis length were positively correlated with intubation time with lightwands [12,18]. SMD is an indicator of neck length and neck extension.…”

“…Numerous studies have shown that body mass index (BMI), Mallampati score, and mouth opening predict difficult intubation with intubation devices such as direct laryngoscopes, videolaryngoscopes, and lightwands [11][12][13][14]. Regarding radiographic indices associated with difficult intubation, tongue area, atlanto-occipital gap, mandibulohyoid distance, and the angle of the anterior-inferior point of the upper incisor with the neck in extension are related to difficult laryngoscopy, while epiglottis length is associated with increased intubation time when using lightwands [15][16][17][18]. Despite the aforementioned advantages of videostylets, no clinical investigation has yet been performed to identify radiographic predictors of difficult intubation with videostylets.…”

A review of the current status and progress in difficult airway assessment research

“…X-ray, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasonography have been widely used to diagnose difficult airway [ 28 ]. X-ray imaging can clearly visualize skeletal structures, and it has led to the proposal of different distances between anatomical points as diagnostic markers of the condition.…”