[Transillumination technique in difficult intubations in heart surgery]

The avoidance of myocardial depression still remains the goal of the management for cardiosurgical patients, also when unexpected difficulties in intubation face the anaesthetist. Therefore the difficult intubation should be managed by a short and easy procedure which provides safe results. To analyse the use of transillumination technique with a lightwand device (Trachlight(R), Laerdale, USA) in case of unexpected difficult intubation is the aim of our report. Methods All cardiosurgical patients (NYHA II - IV) were included from Jan 1998 - Dec 2001. After failure of the first intubation attempt by means of direct laryngoscopy (with non-adjustable vocal cord level) this intubation was qualified as an difficult intubation. In all these cases a lightwand device (Trachlight(R), Laerdale, USA) was applicated. Success, duration of the procedure, blood pressure, heart rate were recorded. Results 195 patients (out of total 7406) who could not be directly intubated by laryngoscopy (vocal cord level and arytenoid cartilage not visible), were classified as a difficult intubation. During the first year 1998 the light guided intubation (LGI) was successful as secondary procedure in 94 %, 3 cases, in which LGI failed the intubation was performed by fiberoptic method or McCoy blade. From 1999 to 2001 all difficult intubation could be managed by light guided intubation. In all cases of unexpected difficult intubation the procedure of the light guided intubation took as less than 3 min. The directly measured arterial blood pressure elevated by 14 % in comparison with the pressure prior to the passage through the larynx. Discussion and Conclusions 1998 after sufficient familiarisation of staff with the light wand device the transillumination technique was introduced as an alternative of using the McCoy blade or of using the fiberoptic method in the case of difficult intubation. Short neck or obesity, which occur as main reasons for intubation problems are surprisingly easy to control by light wand device. Therefore the light guided intubation could be an alternative procedure for unexpected difficult intubation in the setting of adult cardiac anesthesia.