Literature DB >> 25886123

Intubation with oral lightwand with an alternative curvature in a case of temporo-mandibular joint ankylosis.

Bikramjit Das1.   

Abstract

Entities:  

Year:  2014        PMID: 25886123      PMCID: PMC4173588          DOI: 10.4103/0259-1162.128932

Source DB:  PubMed          Journal:  Anesth Essays Res        ISSN: 2229-7685


× No keyword cloud information.
Sir, Conventionally, the curvature of lightwand stylet for oro-tracheal intubation resembles a “hockey-stick.” It is formed by bending 3-6 cm from the distal end to 90° to 120°.[1] For a cuffed tracheal tube this would be just proximal to the cuff. We successfully intubated a child through oral route with lightwand with a different curvature. A 5-year-old male child, weighing 17 kg, with traumatic temporo-mandibular joint ankylosis, was posted for surgery. The patient had an anticipated difficult intubation due to limited mouth opening. As the mouth opening was adequate enough to negotiate an endotracheal tube (ETT), we decided to intubate the child with lightwand through oral route. However, instead of making the conventional “hockey-stick” or “J” shaped curvature, we formed a different curvature of our lightwand stylet. The curvature resembled the shape of introducer tool of ProSeal laryngeal mask airway (LMA). Observing the easy insertion of ProSeal LMA with introducer tool in children, we made this new curve on lightwand. The child was premedicated with ondansetron 1.5 mg, glycopyrrolate 0.2 mg, midazolam 1 mg and fentanyl 30 μg intravenously and was preoxygenated with 100% oxygen. All the standard monitors were placed. The patient was induced with sevoflurane and oxygen. After assessing the adequate depth of anesthesia, intubation was started. The pediatric lightwand curvature was formed using an introducer tool of size 2 ProSeal LMA and was adequately lubricated. The child was placed in “sniffing” position. Lightwand, threaded with a 4.5 mm uncuffed ETT, inserted orally maintaining the midline position. During insertion no resistance was felt. After proceeding few centimeters, a brilliant, translucent, circumscribed red glow was seen over the thyroid cartilage. Then the ETT was pushed further and the lightwand stylet was taken out. Correct positioning of the tube was confirmed by bilateral auscultation of breath sound and square wave capnograph tracings. Patient was maintained with 1-2% sevoflurane with 60% nitrous oxide in oxygen. After completion of surgery, patient was extubated and he had an uneventful post-operative period. Oral intubation through lightwand often becomes necessary where mouth opening is limited, not allowing space for rigid laryngoscope, especially in third world countries, where pediatric fiberscope is not always available. Conventionally the curvature of lightwand for oro-tracheal intubation has been described as “hockey-stick.” In pediatric patients, the reasons for the failure of lightwand intubation (inappropriately large ETT, truly difficult tracheal entry, or other technical problems) are difficult to differentiate.[2] To remedy these ambiguous drawbacks in lightwand intubation, we modify the lightwand intubation procedure. We bent the pediatric lightwand with same curvature of an introducer tool of a size 2 ProSeal LMA. The curvature of introducer tool of ProSeal LMA is made to negotiate it through the oro-hypopharynx without much resistance.[3] We modified the curvature of lightwand assuming that lightwand-ETT assembly would also go smoothly. Intubation in single attempt, smooth passage of ETT without tissue trauma corroborated the rationale of our modification. The modified curvature of lightwand provided a smooth oral intubation in restricted mouth opening scenario without any difficulty. Furthermore, we experienced easy de-threading of wand stylet from ETT after intubation because of smooth curvature instead of right angle bend on conventional “hockey-stick” shape. This modification needs to be used more frequently to establish its safety and efficacy.
  3 in total

Review 1.  Lighted stylet tracheal intubation: a review.

Authors:  L Davis; S D Cook-Sather; M S Schreiner
Journal:  Anesth Analg       Date:  2000-03       Impact factor: 5.108

2.  The LMA 'ProSeal'--a laryngeal mask with an oesophageal vent.

Authors:  A I Brain; C Verghese; P J Strube
Journal:  Br J Anaesth       Date:  2000-05       Impact factor: 9.166

3.  Lightwand intubation of infants and children.

Authors:  Q A Fisher; D E Tunkel
Journal:  J Clin Anesth       Date:  1997-06       Impact factor: 9.452

  3 in total

北京卡尤迪生物科技股份有限公司 © 2022-2023.