Tracheal Intubation Using a Videolaryngoscope Assisted by Transtracheal Illumination with an LED Vein Finder

Abstract

Introduction: Retrograde illumination of the glottis using an LED vein finder placed over the cricothyroid membrane produces a red-orange glow of light inside the airway that can be used to assist the intubator during videolaryngoscopy. The endotracheal tube can be guided through this red-orange glow illuminating the glottis and trachea. Patients and Methods: In this prospective, randomised, single-blinded study, a total of 200 patients posted for elective head and neck cancer surgeries were included. Patients were placed supine with their heads in a neutral position without a pillow. Intubation was done with The Anesthetist Scope videolaryngoscope in Group TI (transillumination) with an assistant holding the LED vein finder over the cricothyroid membrane. The glottic opening was identified by a red-orange glow within the airway and the intubation was performed. In Group C (conventional direct laryngoscopy), transillumination was not done during intubation. Exposure time was taken from the time when the patient's mouth was opened to the time when the best glottic view was obtained. Intubation time was noted from the introduction of the videolaryngoscope or conventional laryngoscope into the mouth, through successful intubation and identification of 3 complete capnographic waveforms. A total of three attempts were allowed for each patient. Results: The success rate was better in Group TI. Exposure time and intubation time were shorter in Group TI as compared to Group C. In three patients with carcinoma of the vocal cords, the glottic opening was identified only by retrograde light transmission from the vein finder. Conclusion: A combination of videolaryngoscopy and LED vein finder is an effective method to achieve a better success rate of tracheal intubation.