Transillumination‐assisted orotracheal intubation: a comparison of the <scp>B</scp>onfils fibrescope and the lightwand (<scp>T</scp>rachlight)

Sui, Jing; Peng, Mao; Liu, J.-H.; Tong, S. Y.; Wei, Ling; Yang, Dong; Deng, Xiao M.

doi:10.1111/j.1399-6576.2011.02627.x

Cited by 7 publications

(10 citation statements)

References 27 publications

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“…A number of studies reported a success rate of BIF intubation to be 82–100% [ 6 , 11 , 12 ]. In this study, the success rate of intubation with the transillumination-assisted technique was 97.3%, similar to that reported by Sui [ 13 ].…”

Section: Discussionsupporting

confidence: 89%

A comparison of the transillumination-assisted technique versus midline approach technique in novices: a prospective randomized controlled trial about the Bonfils intubation fiberscope

Wang

Liu

et al. 2017

BMC Anesthesiol

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BackgroundThe present study aimed to compare the safety and efficacy for novices to conduct intubation with the Bonfils intubation fiberscope (BIF) using the transillumination-assisted or midline approach technique in patients with normal airways.MethodsIn this prospective randomized control study, 10 trainees were assigned to the transillumination-assisted technique group (T group) or the midline approach technique group (R group). Each trainee was required to conduct intubation in 50 patients. The primary outcome was intubation time. The secondary outcomes were success rate (%), number of attempts, and complications.ResultsAmong the cases of successful intubation, the intubation time was not significantly different between the two groups (P > 0.05). The overall success rate of intubation was not significantly different between the two groups (P > 0.05). The intubation success rates at the first, second, and third attempts as well as the average intubation times were similar between the two groups (P > 0.05), but in patients receiving successful intubation at the second attempt, the intubation time was longer in the T group (P = 0.0006). The incidences of dry throat, sore throat, and hoarseness were higher in the T group (all P < 0.05).ConclusionsFor patients with a normal airway, the transillumination-assisted technique was unlikely to increase the success rate of intubation with the BIF compared with the midline approach technique, but led to more complications.Trial registration ChiCTR-INR-16009967, retrospectively registered on November 22, 2016Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0322-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 89%

A comparison of the transillumination-assisted technique versus midline approach technique in novices: a prospective randomized controlled trial about the Bonfils intubation fiberscope

Wang

Liu

et al. 2017

BMC Anesthesiol

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“…Only one group reported the use of a retrograde transillumination technique , but they applied visible light, which does not specifically highlight the airway. Commercially available anterograde transillumination devices such as the Trachlight and Surch‐Lite stylets can be viewed as predecessors of IRRIS, but they have crucial limitations: they require suitably dimmed ambient light conditions (which are not always present); and are strongly dependent on the tissue thickness of the anterior neck region . To send visible light from the anterior surface of the neck in a reverse direction to the larynx, and to view it during direct laryngoscopy, seems to be at first glance a compelling alternative; however, this is technically not possible because visible wavelengths are not suitable to penetrate and selectively illuminate the airway.…”

Section: Discussionmentioning

confidence: 99%

“…However, videolaryngoscopy has certain limitations, in particular, in the hands of less experienced users . Several adjuncts and manoeuvres are suggested to improve performance including using a flexible, rigid or malleable stylet within the tracheal tube to facilitate intubation , or using transillumination (such as with the Trachlight ™ , Saturn Biomedical System Burnaby, BC, Canada, or the Search‐Lite ™ , Bovie Medical Corporation, Clearwater, FL, USA) . One important limitation is that these latter methods require the device itself to intubate the trachea and the light is viewed emitted from within the lumen externally on the skin.…”

Section: Introductionmentioning

confidence: 99%

A new retrograde transillumination technique for videolaryngoscopic tracheal intubation

et al. 2018

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This single-centre, prospective trial was designed to assess the efficacy of a new retrograde transillumination device called the 'Infrared Red Intubation System' (IRRIS) to aid videolaryngoscopic tracheal intubation. We included 40 adult patients, who were undergoing elective urological surgery under general anaesthesia. We assessed the ability to differentiate the transilluminated glottis from other structures and found a median (IQR [range]) larynx recognition time of 8 (5-14 [3-28]) s. The difference in laryngeal visibility on the screen between the deactivated vs. activated device expressed on a visual analogue scale was significant (6 (4-7 [2-10]) vs. 10 (8-10 [4-10]); p < 0.001). The number of laryngoscope insertions was 1 (1-2 [1-3]) and the device showed high values on a visual analogue scale ranging from 0 (lowest score) to 10 (highest score) for helpfulness (6 (5-7 [2-10])), credibility (10 (8-10 [5-10])) and ease of use (10 (9-10 [8-10])). Tracheal intubation with the system lasted 26 (16-32 [6-89]) s. No alternative technique of securing the airway was necessary. The lowest SpO during intubation was 98 (97-99 [91-100])%. We conclude that this method of retrograde transillumination can assist videolaryngoscopy.

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“…

Sir,The recent article of J.-H. Sui et al 1 comparing the transillumination-assisted orotracheal intubation using the Bonfils fibrescope (Karl Storz, Tuttlingen, Germany) and the lightwand [Trachlight (Laerdal Medical Co., Wappingers Falls, NY, USA)] was of great interest. However, although they have provided valuable information, there are several aspects of this study that have to be clarified.

…”

mentioning

confidence: 99%

“…3,5,7 Furthermore, the brightness of its light source is poorer than that of Trachlight, as well reported by the authors. 1 Moreover, the longer intubation times with Bonfils fibrescope compared with Trachlight would be due to an improper use of the device; a first blind oral introduction was followed by an endoscopic view of the operator through the eyepiece to localise the glottis before tracheal tube's insertion. 7,8 We are conscious of the disadvantages of an endoscopic view due to secretions, blood or fogging, 7 but we think that it is the 'gold standard' for Bonfils fibrescope.…”

mentioning

confidence: 99%

Is Trachlight really better than the Bonfils fibrescope?

Falcetta¹,

Pecora²,

Orsetti³

et al. 2012

Acta Anaesthesiol Scand

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Sir,The recent article of J.-H. Sui et al. 1 comparing the transillumination-assisted orotracheal intubation using the Bonfils fibrescope (Karl Storz, Tuttlingen, Germany) and the lightwand [Trachlight (Laerdal Medical Co., Wappingers Falls, NY, USA)] was of great interest. However, although they have provided valuable information, there are several aspects of this study that have to be clarified. We agree with the authors that this is the first detailed report of the transillumination method of modifying the use of the Bonfils fibrescope, but the results of this study should be extrapolated to the clinical settings with caution. As well reported in literature, 2-7 the best intubation techniques with Bonfils fibrescope (paraglossic or retromolar) involves a continuous endoscopic vision, beginning from introduction into the oral cavity to the visualisation of the vocal cords. Because of its fixed curvature and rigid metallic structure, it could be very dangerous using this device with a blind transoral technique, as proved by the complications that occurred in this study (sore throat 14% and hoarseness 8.7%) 1 and the absence of these when using it correctly. 3,5,7 Furthermore, the brightness of its light source is poorer than that of Trachlight, as well reported by the authors. 1 Moreover, the longer intubation times with Bonfils fibrescope compared with Trachlight would be due to an improper use of the device; a first blind oral introduction was followed by an endoscopic view of the operator through the eyepiece to localise the glottis before tracheal tube's insertion. 7,8 We are conscious of the disadvantages of an endoscopic view due to secretions, blood or fogging, 7 but we think that it is the 'gold standard' for Bonfils fibrescope. In 2006, Biro et al. 9 proved that aptitude for endoscopic viewing, more than experience and skill in standard laryngoscopy, could improve the learning curve of rigid fibrescope utilisation, so the use of this device is not intuitive and needs a greater learning curve when compared with blind devices as Trachlight. 5-7 The Bonfils fibrescope was previously compared with the intubating laryngeal mask airway 10 after conventional laryngoscopy failed. The results of this study found a comparable success rate, but a significantly shorter time to intubation and a decreased postanaesthesia airway morbidity was noted in the Bonfils group. We believe that the possibility to advance the endotracheal tube under direct visualisation avoids some of the complications associated with intubation using blind devices. X-M. Transillumination-assisted orotracheal intubation: a comparison of the Bonfils fibrescope and the lightwand (Trachlight).

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Transillumination‐assisted orotracheal intubation: a comparison of the Bonfils fibrescope and the lightwand (Trachlight)

Abstract: For patients with normal airways, the Trachlight is superior for orotracheal intubation with respect to reliability, rapidity, and safety compared with the Bonfils fibrescope used with the transillumination technique.

Cited by 7 publications

References 27 publications

A comparison of the transillumination-assisted technique versus midline approach technique in novices: a prospective randomized controlled trial about the Bonfils intubation fiberscope

A comparison of the transillumination-assisted technique versus midline approach technique in novices: a prospective randomized controlled trial about the Bonfils intubation fiberscope

A new retrograde transillumination technique for videolaryngoscopic tracheal intubation

Is Trachlight really better than the Bonfils fibrescope?

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