Comparison of the lightwand technique with direct laryngoscopy for awake endotracheal intubation in emergency cases

Abstract

Study Objective: To clarify the efficacy of the lightwand technique compared with that of the conventional laryngoscopic technique for awake endotracheal intubation in patients requiring emergency surgery. Design: Prospective clinical study. Setting: Anesthesia department of a teaching hospital. Patients: 60 ASA physical status IE patients undergoing emergency surgery. Interventions: Awake intubations using the lightwand technique (LW group) and a laryngoscope (LS group) were performed with conscious sedation with midazolam and fentanyl. Measurements and Main Results: Time to intubation and number of intubation attempts in the LW group were significantly shorter and smaller, respectively, than those in the LS group (p < 0.01). Fewer LW group patients complained of a sore throat than in the LS group. ΔP [changes from “before intubation” to “immediately after intubation” in mean arterial pressure (MAP)] in the LS group was significantly larger than that in the LW group ( p < 0.05), although doses of sedatives in the two groups were not different. No hypoxemia or apnea associated with sedation was found in either of the groups. Conclusions: The lightwand technique produces less magnitude of stress following tracheal intubation than does the conventional laryngoscopic technique for awake intubation. Lightwand-assisted awake intubation is thought to be a useful means for induction of anesthesia in cases of emergency surgery.