Use of Lightwand for Nasotracheal Intubation in Adult Patients with Limited Mouth Opening Undergoing Elective Surgery. | [Anaesthesia, Pain and Intensive Care • 2015]

Author(s):

1. Vipin Kumar Dhama: Department of Community Medicine, LalaLajpat Rai Memorial Medical College (LLRMC), Garh Road, Jai Bhim Nagar, Meerut, Uttar Pradesh, India

2. Yogesh Kumar Manik: Department of Community Medicine, LalaLajpat Rai Memorial Medical College (LLRMC), Garh Road, Jai Bhim Nagar, Meerut, Uttar Pradesh, India

3. Tanmay Tiwari: Department of Community Medicine, LalaLajpat Rai Memorial Medical College (LLRMC), Garh Road, Jai Bhim Nagar, Meerut, Uttar Pradesh, India

4. Ganesh Singh: Department of Community Medicine, LalaLajpat Rai Memorial Medical College (LLRMC), Garh Road, Jai Bhim Nagar, Meerut, Uttar Pradesh, India

5. Subhash: Department of Community Medicine, LalaLajpat Rai Memorial Medical College (LLRMC), Garh Road, Jai Bhim Nagar, Meerut, Uttar Pradesh, India

Abstract:

Objective: Lightwand is a device which utilizes the principle of transillumination to assist endotracheal intubation.The authors evaluated the role of lightwand for nasotracheal intubation in patients having limited mouth opening on PAC assessment. Lightwand guided nasal intubation can be used for airway management where a fiberoptic bronchoscope is not always available. In elective surgery where the anesthetist has time to plan for airway management, lightwand can be an easy to use device. Methodology: Patients of both sexes, ASA physical status I or II, aged between 20 and 50 years, BMI (body mass index) between 18-25, and having mouth opening between 1-4 cm on PAC were included in our feasibility study. Ketofol (ketamine + propofol combination) was used to provide analgesic sedation. Lightwand was inserted into endotracheal tube and tip was bent into J shape before entering nasal cavity. Duration of procedure was calculated as the time between entry of lightwand into nose and starting of ETCO2 waveform on monitor after attaching the breathing circuit. Our study evaluated the lightwand guided nasotracheal intubation, hemodynamic changes and incidence of airway complications in 40 adult non-pregnant patients. Heart rate, systolic, diastolic and mean blood pressures were measured at 0, 1, 2, 5 and 10 min. Statistical analysis was done by using SPSS version 20. Paired T-test was used to compare all the baseline values to different time intervals. Results: Total time to perform intubation using lightwand was 94.44 ± 27.43 sec in our study. Hemodynamic changes (heart rate, blood pressure) in our study showed a significant increase from baseline values. Eight patients fulfilled our criteria of pain in posterior pharynx on swallowing. An equal number of patients had hoarseness of voice in post op period. In 3 patients nasotracheal intubation could not be done within 5 min (300 sec) and were excluded from the study. Conclusion: We conclude that lightwand may be used as an option for assisting nasotracheal intubation in patients with limited mouth opening when fiberoptic bronchoscope is not available.

Page(s): 468-472

DOI: DOI not available

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 19, Issue: 4, Year: 2015

Keywords:

Keywords are not available for this article.

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