Lighted stylet tracheal intubation: a review.

Abstract

Tracheal intubation is older than the recognized his-tory of general anesthesia itself. In the late 18th cen-tury, The Royal Humane Society of London used tra-cheal intubation for resuscitating the near-drowned.Approximately 100 years later, MacEwan (1) per-formed a digital tracheal intubation in an awake pa-tient before a chloroform and air general endotrachealanesthetic for the resection of a tongue tumor, and in1928, Magill (2) incorporated blind nasal tracheal in-tubation as a part of a general anesthetic. Althoughlaryngoscopes were invented in the 19th century, tra-cheal intubation under direct visualization was greatlyenhanced by the development of a special laryngo-scope blade by Macintosh (3) in 1943.The first reported use of a lighted stylet used tofacilitate intubation came in 1957 when (by now SirRobert) Macintosh (4) described an 18-inch illumi-nated tracheal tube introducer, which was designed tostiffen the tube and better illuminate the cords bysupplementing the light of the laryngoscope. Berman(5) described a similar device in 1959 and said it wasuseful “when the fickle light of the laryngoscope hasgone out at the most inopportune time.” In the sameyear, Yamamura et al. (6) described a light bulb-tippedwire that was inserted into the tracheal tube beforeblind nasal intubation in awake patients. The tubeposition was then determined by the medial transillu-mination of the external throat and neck.In 1977, Foster (7) used a transilluminating fiberop-tic bundle to facilitate tracheal intubation in a youngchild with trismus, and Ducrow (8), in the followingyear, used a flexible surgical light (Flexi-lum™, Con-cept Corporation, Clearwater, FL) to achieve the sameend by first passing a guide (two plastic suction cath-eters connected end-to-end) into the trachea followedby passage of the tracheal tube over the guide. In acorrespondence to the latter article, Rayburn (9) com-mented that the Flexi-lum™ could be positioned in-side the tracheal tube, thereby shortening the intuba-tion sequence and claimed that the technique,nicknamed “lightwand intubation,” had been used forsome years at the Brooke Army Medical Center.