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• W4253560160 abstract "To the Editor: We read with great interest the letter to the editor by Asai et al. [1] in which they suggest the use of a lighted stylet to facilitate tracheal intubation (TI) through the intubating laryngeal mask (ILM). We describe our experience concerning the advantages of a light-guided technique by using a prototype lighted flexible catheter (LFC) for TI through the ILM. The LFC consists of a completely flexible thin plastic catheter, a bulb attached to its distal end, a 15-mm concentric adaptor at its proximal end, and an extension ending in a battery with a power switch (Figure 1). The device is placed into a straight cuffed silicone tracheal tube (TT) in such a way that the bulb protrudes from the distal end of the TT.Figure 1: Prototype lighted flexible catheter.After institutional review board approval, informed consent was obtained in 80 patients (male to female ratio 40:40), ASA physical status I-III, aged 51 +/- 20 (range 18-86) yr, weight 73 +/- 14 (45-116) kg scheduled to undergo propofol/fentanyl/atracurium anesthesia for elective surgery. No patient was considered at risk of difficult TI or aspiration of gastric contents. All participants underwent a randomized, double-comparative, cross-over trial with respect to the TI technique through the ILM, i.e., blind TI according to the conventional methodology [2] versus light-guided TI using the LFC. Both techniques were applied in all participants by two intubators. Each intubator performed one of the two techniques in each patient (ILM placement and TI) and was unaware of the final outcome of the other intubator. The light-guided TI was performed as follows: the TT preloaded with the LFC was inserted through the ILM and, by observing the glow on the neck, was advanced into the trachea. Whenever resistance was felt during TT insertion, appropriate adjusting maneuvers were performed by moving the metal handle of the ILM. The number of maneuvers performed, the number of attempts at TT insertion, the total duration of the procedures, and the final outcome were recorded in both techniques. Failure to intubate was defined as inability to place the TT successfully after four maneuvers of the ILM and/or five attempts at TT insertion. The ILM was placed successfully in all patients. Table 1 shows the main results. The duration of light-guided TI was significantly shorter compared with that of blind TI (32 +/- 10 s vs 44 +/- 19 s; P < 0.0001).Table 1: Maneuvers of Intubating Laryngeal Mask and Attempts at Tracheal Tube InsertionsThe LFC uses the transillumination of the light through the soft tissues of the neck as a guide for the successful insertion of the TT from the laryngopharynx to the trachea. Thereafter, it changes the conventional technique of TI through the ILM from blind to guided, and in this way improves the success rate, reduces the duration, and diminishes the numbers of maneuvers and TT insertions attempts. Vasilios Dimitriou, MD, DEAA Gregory S. Voyagis, MD Department of Anesthesiology; G. Gennimatas and Sotiria Hospitals; Athens, Greece" @default.
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• W4253560160 date "1999-07-01" @default.
• W4253560160 modified "2023-10-03" @default.
• W4253560160 title "Use of a Prototype Flexible Lighted Catheter for Guided Tracheal Intubation Through the Intubating Laryngeal Mask" @default.
• W4253560160 cites W2138258166 @default.
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• W4253560160 doi "https://doi.org/10.1213/00000539-199907000-00052" @default.
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