Light-guided retrograde intubation

Transillumination of the soft tissues using a lightwand (Trachlight) can guide the endotracheal tube (ETT) 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.

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 i.v. catheter, an epidural catheter was advanced cephalad into the oropharynx. While pulling the epidural catheter taut, the ETT, with the Trachlight 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 ETT into the trachea were recorded.

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.

In a small number of patients, we have shown that light-guided retrograde intubation is effective and sale for patients with cervical spine instability. This simple and inexpensive technique may prove to be a valuable adjunct in the management of difficult airways.