Cautious Use of Trachlight™ in Infants

Abstract

To the Editor: Trachlight™ is a device for tracheal intubation without requiring direct laryngoscopy (1,2). There have been several reports regarding its effectiveness for intubating difficult airways (3–5). We attempted tracheal intubation on an infant with a small chin. Tracheal intubation using direct laryngoscopy was unsuccessful. Neither blind nasal intubation nor intubation with a flexible bronchoscope was possible. We therefore tried tracheal intubation using the Trachlight™. We were able to successfully intubate the trachea using the Trachlight™ without requiring a muscle relaxant. Our patient had significant bucking and breath-holding just after intubation. If intubation had not been successful, there would have been a danger of laryngospasm. Because the infant's neck was uniformly and powerfully transilluminated, we were unable to determine the position of the tube tip (Fig. 1) in the trachea. We believe that the quantity of light produced by the Trachlight™ is too bright for use in newborns and infants, and improvements in the device are necessary for optimal use in this population. Fiberoptic intubation through a laryngeal mask airway (LMA) was considered for this patient (6,7). In this case we used Trachlight™ before the use of LMA, and we were successful. However, a LMA might have induced less response in the unrelaxed airway. This method should be considered when others forms of tracheal intubation prove unsuccessful.Figure 1.: A 35-day-old male infant, 1800 g, 44 cm, with Dandy-Walker syndrome with frequent malformation (e.g., a little chin symptom). Because thin tissue of the neck was transilluminated uniformly and powerfully, we were unable to determine the position of the tracheal tube tip using Trachlight™.Masashi Nishikawa, MD Shinichi Inomata, MD Department of Anesthesiology University of Tsukuba Tsukuba City, Ibaraki Japan [email protected]