The use of the lightwand for endotracheal intubation has been demonstrated to be a useful technique, particularly after failed laryngoscopy . It is included in the American Society of Anesthesiologists' difficult airway algorithm as well . Moreover, Friedman et al. noted that patients had less dysphagia, dysarthria and a lower severity of sore throat with lightwand intubation than with standard laryngoscopy.
With the traditional teaching for lightwand intubation, the clinician holds the wand similar to a pencil, stands directly behind the patient's head, inserts the device into the side of the mouth and sweeps the tip to the midline . Our teaching varies considerably from this approach and allows all providers to safely and quickly perform lightwand intubations, regardless of their level of experience.
The key aspect of our approach involves having the clinician stand to the left of the patient's head instead of the traditional intubating position. This stance provides numerous advantages. First, it gives the clinician a better view of the anterior neck by placing one's eyes directly above the target – the glottis. Second, it improves the degree of jaw thrust the clinician is able to provide with the left hand (thereby lifting the epiglottis away from the vocal cords). Third, standing to the patient's left forces the intubating right arm into a more rigid, elbow-elevated position. With the elbow elevated, glottic entry is smoother because it allows the clinician to gently pull the wand across the body in order to lift the light into the glottis (Fig. 1). Finally, this position allows the clinician to slide the endotracheal tube off the lightwand using the left hand because the right arm is now rigidly fixed upon entry through the glottis. This approach has greatly simplified every aspect of the procedure for us and has shortened its duration to a matter of seconds, regardless of the clinician's level of experience.
1 Weis FR, Hatton MN. Intubation by use of the light wand: experience in 253 patients. J Oral Maxillofac Surg 1989; 47:577–580.
2 American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology
3 Friedman PG, Rosenberg MK, Lebonbom-Mansour M. A comparison of light wand and suspension laryngoscopic intubation techniques in outpatients. Anesth Analg 1997; 85:578–582.
4 Davis L, Cook-Sather SD, Schreiner MS. Lighted stylet tracheal intubation: a review. Anesth Analg 2000; 90:745–756.