Light-guided retrograde intubation

Purpose: Transillumination of the soft tissues using a lightwand (Trachlight(TM)) can guide the endotracheal tube (E-TT) into the glottis to facilitate the retrograde intubation. This study evaluated the effectiveness and safety of this intubating technique for patients with cervical spine instability. Methods: After obtaining institutional approval and informed consent, 27 patients were studied. Light-guided retrograde intubation was performed either awake, or under general anaesthesia. Following cricothyroid membrane puncture using a # 18 iv catheter, an epidural catheter was advanced cephalad into the oropharynx. While pulling the epidural catheter taut, the ETT; with the Trachlight(TM) in place, was advanced into the glottis. When the tip of the ETT entered the glottis, a bright glow was seen in the anterior neck, The number of attempts, failures, complications, the times required to puncture the cricothyroid membrane, insert the epidural catheter, and insert the E-TT into the trachea were recorded. Results: In all patients, the tracheas were successfully intubated. The mean (+/- sd) time to perform cricothyroid puncture, insert the epidural catheter, and place the ETT into the trachea were 66.1 +/- 56.2, 74.0 +/- 25.2, and 72.8 +/- 42.5 sec respectively. The average total-time for this light-guided retrograde intubating technique was 205.8 +/- 78.3 sec. Apart from minor bleeding at the cricothyroid membrane puncture site, there were no major complications. Conclusion: In a small number of patients, we have shown that light-guided retrograde intubation is effective and safe for patients with cervical spine instability. This simple and inexpensive technique may prove to be a valuable adjunct in the management of difficult airways.