Minimum and optimum light requirements for laryngoscopy in paediatric anaesthesia: a manikin study

Direct laryngoscopy is performed regularly in paediatric anaesthetic practice for the purpose of intubating a patient's trachea. A minimum illumination of 700 lux at a distance of 20 mm has been suggested in a draft standard for laryngoscopes from the International Organization for Standardization. We investigated the minimum and optimum illumination required by anaesthetists during laryngoscopy. Fifty anaesthetists were recruited to perform laryngoscopy on a child manikin with a selection of laryngoscope blades and bulbs attached to a variable voltage supply. There was a large variation in the illumination range of different bulb and blade combinations. We demonstrated a large interindividual variability between anaesthetists for illumination requirements during laryngoscopy. Anaesthetists can see the larynx at very low light levels, but optimum illumination was significantly greater than minimum illumination. Two of the six combinations could produce more than 700 lux. In all, 78% and 54% of anaesthetists considered 700 lux too bright with a halogen and xenon bulb, respectively. Our study suggests that the proposed standard of 700 lux may possibly be too bright.