Lightwand Intubation Research Articles

Comparison of lightwand intubation technique in neck-immobilized patients with face-to-face and conventional approaches

Comparison of lightwand intubation technique in neck-immobilized patients with face-to-face and conventional approaches

Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation.

A lightwand is a stylet with a light bulb at its tip that can be used to guide intubation by confirming the illumination through the anterior neck. We aimed to determine the factors affecting the illumination intensity during lightwand endotracheal intubation. We retrospectively collected data from 180 patients who underwent lightwand endotracheal intubation. We recorded illumination intensity on a 5-point scale. The patients were categorized into weak (score <3) and bright (score ≥3) groups based on the illumination intensity scale score. A total of 176 patients were analyzed, of whom 125 (71.1%) were enrolled in the bright group, and 51 (29.0%) were enrolled in the weak group. Multivariable logistic regression analysis revealed that an increased body mass index (BMI) and mask ventilation grade were associated with light intensity. For mask ventilation, moderate vs. easy (p=0.010) and difficult vs. easy (p=0.008) were associated with the weak group. Receiver operating characteristic curve analysis showed that BMI ≥24.6 kg/m2 was correlated with the weak group. BMI ≥24.6 kg/m2 or mask ventilation grade above moderate indicates increased odds of weak illumination intensity in lightwand intubation. Pre-intubation examination of these factors helps increase the chances of successful intubation.

A COMPARATIVE STUDY BETWEEN LIGHT WAND AND AIRTRAQ AIDED TRACHEAL INTUBATION FOR ADULT PATIENTS WITH DIFFICULT AIRWAY UNDERGOING ELECTIVE SURGERY UNDER GENERAL ANESTHESIA

Objective: The objective of the study was to compare airtraq (AT) intubations and lightwand (LW) intubations in terms of safety, efficacy, ease of intubation, hemodynamic variabilities, and post-operative outcomes. Methods: A cross-sectional and randomized comparative study was conducted on sixty adult patients with a predicted difficult airway, scheduled to undergo elective surgery under general anesthesia using AT and LW intubation. Results: All the cases in both the AT group and LW group were successfully intubated, with an overall success rate of 100% in both groups. The success at the first attempt in AT group was 96.66% and that of LW group was 73.33%. Conclusion: AT had superior successful intubation conditions than LW. However, both LW and AT were proved to be safe and successful techniques of intubation in difficult airway patients.

Evaluation of transmitted glow point at a priori chosen depth (1 cm below vocal cords) for lightwand intubation: a prospective observational study.

ObjectiveWhen performing lightwand intubation, an improper transmitted glow position before tube advancement can cause intubation failure or laryngeal injury. This study was performed to explore the transmitted glow point corresponding to a priori chosen depth for lightwand intubation.MethodsBefore lightwand intubation, we marked the transmitted glow point from a bronchoscope on the neck when it reached 1 cm below the vocal cords. Lightwand intubation was then performed using this marking point. The distances from the mark to the upper border of the thyroid cartilage, upper border of the cricoid cartilage, and suprasternal notch were measured.ResultsIn total, 107 patients were enrolled. The success rate of lightwand intubation using the mark was 93.5% (95% confidence interval, 88.7%–99.2%) at the first attempt. The marking point was placed 12.0 mm (95% confidence interval, 10.6–13.4 mm) below the upper border of the cricoid cartilage.ConclusionAnaesthesiologists should be aware of the appropriate point of the transmitted glow on the patient’s neck when performing lightwand intubation. We suggest that this point is approximately 1 cm below the upper border of the cricoid cartilage.Trial registration: ClinicalTrials.gov NCT03480035

Dosing study of esmolol for reducing hemodynamic changes during lightwand intubation.

BackgroundLightwand is a convenient tool that can be used instead of a laryngoscope for intubation. Tracheal intubation causes direct stimulation of the larynx, drastically increasing hemodynamic values including blood pressure and heart rate. This study aims to identify the effect of different doses of esmolol on hemodynamic changes during lightwand intubation.MethodsThe study subjects included 140 patients who underwent general anesthesia for elective surgery. The patients were randomly divided into four groups (35 patients in each group). The ‘C’ group only received 20 ml of normal saline, while the ‘E0.5’, ‘E1’, and ‘E2’ groups received 20 ml of normal saline containing esmolol—0.5 mg/kg, 1 mg/kg, and 2 mg/kg, respectively, injected 2 min prior to intubation. The patients’ blood pressure, heart rate, and rate-pressure product were measured six times, before and after the intubation.ResultsThe degree of heart rate elevation was suppressed in the E1 and E2 groups compared to the C group, and RPP after intubation significantly decreased in the E2 group compared to the C group.ConclusionsEsmolol injection, 1-2 mg/kg, prior to lightwand intubation effectively blunts heart rate elevation, and 2 mg/kg of esmolol injection blunts rate-pressure product elevation.

A Comparison Between the Conventional and the Laryngoscope-Assisted Lightwand Intubation Techniques in Patients With Cervical Immobilization: A Prospective Randomized Study

Positioning of a lightwand in the midline of the oral cavity can be challenging in patients with cervical immobilization. Direct laryngoscopy may permit the lightwand tip to more easily access the glottic opening. We tested our hypothesis that a laryngoscope-assisted lightwand technique allows more successful endotracheal intubation than does a conventional lightwand approach. A total of 162 patients requiring cervical immobilization during intubation for cervical spine surgery were allocated randomly to 2 groups. The conventional lightwand technique (group C, n = 80) or the laryngoscope-assisted lightwand technique (group L, n = 82) was used for endotracheal intubation. In the group L, a Macintosh laryngoscope was inserted into the oral cavity, advanced until the epiglottis tip was visible, but not used to lift the epiglottis tip. The lightwand tip was placed below the epiglottis under direct view of the epiglottis tip. The primary outcome (the initial intubation success rate) and secondary outcomes (intubation time, hemodynamic changes, and postoperative airway complications) were evaluated. The initial intubation success rate was significantly lower (75% vs 89%; relative risk [95% confidence interval]: 1.2 [1.0-1.4]; P = .034) in group C than group L. The intubation time (22 ± 13 vs 24 ± 12 seconds; mean difference [98.33% confidence interval]: 2.4 [-2.3 to 7.2]; P = .217) did not differ between groups. Postoperative sore throat score, incidences of hypertension and tachycardia, postoperative oral mucosal bleeding, and hoarseness also did not differ between groups. Laryngoscope-assisted lightwand intubation did not increase intubation time, and it increased first attempt intubation rates compared with traditional lightwand intubation in patients requiring cervical immobilization for cervical spine surgery.

A Randomized Crossover Study Comparing Cervical Spine Motion During Intubation Between Two Lightwand Intubation Techniques in Patients With Simulated Cervical Immobilization: Laryngoscope-Assisted Versus Conventional Lightwand Intubation.

In patients with cervical immobilization, jaw thrust can cause cervical spine movement. Concurrent use of a laryngoscope may facilitate lightwand intubation, allowing midline placement and free movement of the lightwand in the oral cavity without jaw thrust. We compared the effects of laryngoscope-assisted lightwand intubation (LALI) versus conventional lightwand intubation (CLI) on cervical spine motion during intubation in patients with simulated cervical immobilization. In this randomized crossover study, the cervical spine angle was measured before and during intubation at the occiput-C1, C1-C2, and C2-C5 segments in 20 patients with simulated cervical immobilization who underwent intubation using both the LALI and CLI techniques. Cervical spine motion was defined as the change from baseline in angle measured at each cervical segment during intubation. Cervical spine motion at the occiput-C1 segment was 5.6° (4.3) and 9.3° (4.5) when we used the LALI and CLI techniques, respectively (mean difference [98.33% CI]; -3.8° [-7.2 to -0.3]; P = .007). At other cervical segments, it was not significantly different between the 2 techniques (-0.1° [-2.6 to 2.5]; P = .911 in the C1-C2 segment and -0.2° [-2.8 to 2.5]; P = .795 in the C2-C5 segment). The LALI technique produces less upper cervical spine motion during intubation than the CLI technique in patients with simulated cervical immobilization.

Optimal remifentanil dose for lightwand intubation without muscle relaxants

Editor, In a randomised clinical study, Jeon et al.1 concluded that in healthy patients with a normal airway, remifentanil 2 or 3 μg kg−1 combined with thiopental 5 mg kg−1 provided acceptable conditions for lightwand intubation without muscle relaxants. However, in our view, there are several issues related to the study design that warrant cautious interpretation of the results. First, after induction of anaesthesia with remifentanil and thiopental, facemask ventilation was maintained for 60 s with 2% sevoflurane in 50% nitrous oxide in oxygen at a total flow rate of 4 l min−1 in all patients. Because sevoflurane has a low blood-gas solubility coefficient (0.67), its onset is very fast.2 Moreover, a synergistic interaction for sedation and analgesia has been shown between remifentanil and sevoflurane.3,4 Thus, we believe that if sevoflurane had not been used during induction of anaesthesia, as in previous studies,5,6 a different result would have been obtained. Second, just like their and other studies have shown,1,7 adequate depth of anaesthesia is critical to successfully perform blind lightwand intubation without muscle relaxants. Inadequate depth of anaesthesia can result not only in delay or failure of lightwand intubation, but also puts the patients at risk of laryngospasm, and even airway damage, due to incomplete relaxation of the larynx. Moreover, in managing difficult airways, smooth intubation without coughing is an important factor to ensure a safe procedure. Thus, we argue that criteria of ‘good’ intubating conditions in this study should not have included a cough response after tracheal intubation, because it is a sign of inadequate inhibition of airway reflexes in anaesthetised patients.8 Also, it is questionable whether the advantage of a faster return to spontaneous ventilation should be achieved at the expense of inferior intubating conditions, especially when managing difficult airways, such as in patients with cervical injury. Third, the sample size calculation in this study was based on a previously similar study,6 and a sample size of 32 patients per group was selected to detect a projected difference of 30% between the groups, with respect to excellent intubating conditions for a type I error of 0.05 and a power of 0.8. Because there was only an absolute difference of 18% (84 versus 66%) in excellent intubating conditions between groups R2 and R3, a statistically significant difference was not achieved. However, the small sample size may have prevented the authors from excluding a type II error when comparing the incidences of excellent intubating conditions between groups R2 and R3. Assuming that the difference of 18% was real, about 85 patients per group would have been required to have an 80% chance of finding a difference. Therefore, this small sample study does not allow the conclusion that remifentanil 2 and 3 μg kg−1, administered concomitantly with thiopental 5 mg kg−1, may provide acceptable conditions for lightwand intubation without muscle relaxants. Fourth, in the methods section, there was no mention of whether intubating conditions and duration of apnoea were assessed by an independent investigator unaware of the doses of remifentanil. If not so, validity of these data remains questionable. Acknowledgements Assistance with the letter: none declared. Financial support and sponsorship: none declared. Conflicts of interest: none declared.

Lightwand-guided nasotracheal intubation in oromaxillofacial surgery patients with anticipated difficult airways: a comparison with blind nasal intubation

In oromaxillofacial surgery patients, the incidence of difficult airways is up to 15.4–16.9%. Blind nasal intubation remains a safe technique for difficult airway management in some remote areas where a fibreoptic bronchoscope is not always available. The lightwand is an easy-to-use, highly economical device, and can facilitate endotracheal intubation through illumination in the neck. The study aims to evaluate the efficacy of nasotracheal intubation using lightwand in oromaxillofacial surgery patients with difficult airways. One hundred and sixteen patients with difficult airways requiring nasotracheal intubation were randomly divided into a lightwand group and a blind group, with 58 cases in each group. The first attempt and overall success rates of lightwand intubation were 84.5% and 93.1%, respectively, which were higher than those of blind intubation (65.5% and 75.9%, respectively; P<0.05). The total intubation time was 91.4±27.7s in the lightwand group and 130.7±33.4s in the blind group (P<0.001). Patients in the lightwand group also experienced more stable haemodynamic responses and less pharyngalgia. In conclusion, lightwand-guided nasotracheal intubation is superior to blind intubation in patients with difficult airways, with a higher success rate, more stable haemodynamic responses, and fewer postoperative complications.

Optimal remifentanil dose for lightwand intubation without muscle relaxants in healthy patients with thiopental coadministration

Muscle relaxants used to facilitate tracheal intubation have disadvantages. This study was designed to evaluate the dose requirements for remifentanil combined with thiopental for optimal lightwand intubation without muscle relaxants. Prospective randomised controlled study. A tertiary care teaching hospital. Ninety-six patients requiring general anaesthesia for elective surgery. Patients received remifentanil 1, 2, or 3 μg kg(-1) (group R1, R2, R3, each n = 32) as a slow bolus infusion over 60 s, followed by thiopental 5 mg kg(-1). Ninety seconds after remifentanil administration, lightwand intubation was attempted and intubation time was recorded. Intubating conditions were considered excellent if there was no patient movement or cough, good if coughing occurred once or twice after intubation and poor if persistent movement or cough occurred after intubation. Excellent or good intubating conditions were regarded as clinically acceptable. The duration of apnoea was recorded. Intubating conditions and the duration of apnoea. Lightwand intubation was successful at the first attempt in all patients except for two in group R1. The intubating conditions were more acceptable in groups R2 and R3 than in group R1 (97 and 100 vs. 63%, P < 0.01). Intubation time was shorter in group R3 than in group R1 (22 ± 8 vs. 33 ± 18 s, P < 0.01). There was no significant difference in intubation time and conditions between groups R2 and R3. The mean duration of apnoea was prolonged in group R3 compared with group R2 (10.2 ± 2.1 vs. 4.6 ± 1.6 min, P < 0.01). Our results suggest that remifentanil 2 or 3 μg kg(-1) combined with thiopental 5 mg kg provides acceptable conditions for lightwand intubation without muscle relaxants. Spontaneous ventilation returns more rapidly following remifentanil 2 μg kg(-1) than with remifentanil 3 μg kg(-1).

Lightwand intubation for difficult airway patients with limited management options

Lightwand intubation for difficult airway patients with limited management options

The optimal effect-site concentration of remifentanil for lightwand tracheal intubation during propofol induction without muscle relaxation

Study Objective To determine the most suitable effect-site concentration of remifentanil during lightwand intubation when administered with a target-controlled infusion (TCI) of propofol at 4.0 μg/mL without neuromuscular blockade. Design Prospective study using a modified Dixon's up-and-down method. Setting Operating room of an academic hospital. Patients 28 ASA physical status 1 and 2 patients, aged 18-65 years, scheduled for minor elective surgery. Interventions Anesthesia was induced by TCI propofol effect-site concentration to 4.0 μg/mL, and the dose of remifentanil given to each patient was determined by the response of the previously tested patient using 0.2 ng/mL as a step size. The first patient was tested at a target effect-site concentration of 4.0 ng/mL of remifentanil. If intubation was successful, the remifentanil dose was decreased by 0.2 ng/mL; if it failed, the remifentanil dose was increased by 0.2 ng/mL. Successful intubation was defined as excellent or good intubating conditions. Measurements and Main Results The remifentanil effect-site concentration was measured. The optimal effect-site concentration of remifentanil for lightwand tracheal intubation during propofol induction using 2% propofol target effect-site concentration to 4 μg/mL was 2.16 ± 0.19 ng/mL. From probit analysis, the effect-site concentration of remifentanil required for successful lightwand intubation in 50% (EC50) and 95% (EC95) of adults was 2.11 ng/mL (95% CI 1.16-2.37 ng/mL) and 2.44 ng/mL (95% CI 2.20-3.79 ng/mL), respectively. Conclusion A remifentanil effect-site concentration of 2.16 ± 0.19 ng/mL given before a propofol effect-site concentration of 4 μg/mL allowed lightwand intubation without muscle relaxant.

Modified lightwand intubation in a child with spondyloepiphyseal dysplasia congenita

This is the case report on a 1-year 9-month-old boy suffering from spondyloepiphyseal dysplasia congenita who was successfully intubated with our modified lightwand intubation procedure for general anesthesia to undergo bilateral herniorrhaphy despite the great likelihood of facing a difficult airway because of unstable cervical spine. We bent the pediatric wand after it was encased in an endotracheal (ET) tube of appropriate diameter. The light tip of the wand was let to protrude just out of the bevel of the ET tube. Once the light bulb properly transilluminated the trachea, the ET tube was threaded gently into the trachea. The patient recovered from anesthesia smoothly and was discharged on the next day. This maneuver can facilitate both visual and tactile confirmations of the position and proper tube size. The effectiveness and safety of our modified lightwand intubation procedure is well demonstrated.

A novel technique for learning to intubate with the lightwand

Editor, The use of the lightwand for endotracheal intubation has been demonstrated to be a useful technique, particularly after failed laryngoscopy [1]. It is included in the American Society of Anesthesiologists' difficult airway algorithm as well [2]. Moreover, Friedman et al.[3] noted that patients had less dysphagia, dysarthria and a lower severity of sore throat with lightwand intubation than with standard laryngoscopy. With the traditional teaching for lightwand intubation, the clinician holds the wand similar to a pencil, stands directly behind the patient's head, inserts the device into the side of the mouth and sweeps the tip to the midline [4]. Our teaching varies considerably from this approach and allows all providers to safely and quickly perform lightwand intubations, regardless of their level of experience. The key aspect of our approach involves having the clinician stand to the left of the patient's head instead of the traditional intubating position. This stance provides numerous advantages. First, it gives the clinician a better view of the anterior neck by placing one's eyes directly above the target – the glottis. Second, it improves the degree of jaw thrust the clinician is able to provide with the left hand (thereby lifting the epiglottis away from the vocal cords). Third, standing to the patient's left forces the intubating right arm into a more rigid, elbow-elevated position. With the elbow elevated, glottic entry is smoother because it allows the clinician to gently pull the wand across the body in order to lift the light into the glottis (Fig. 1). Finally, this position allows the clinician to slide the endotracheal tube off the lightwand using the left hand because the right arm is now rigidly fixed upon entry through the glottis. This approach has greatly simplified every aspect of the procedure for us and has shortened its duration to a matter of seconds, regardless of the clinician's level of experience.Fig. 1

A comparison of lightwand and laryngoscopic intubation techniques in patients undergoing laparoscopic cholecystectomy

Objective To assess the effects of lightwand and laryngoscopic intubation techniques in patients undergoing laparoscopic cholecystectomy (LC). Methods 300 ASA physical status I and II patients, undergoing LC, were randomly assigned to two groups, with 150 cases in each group. Patients in the LS group underwent endotracheal intubation using a standard direct-suspension laryngoscopic technique. Patients in the LW group were intubated by using transillumination with a lightwand. Mean arterial pressure and heart rate were recorded before induction, and at 1, 3 and 5 min after intubation. The incidence and of sore throat, hoarseness, and dysphagia was assessed twenty-four hours after surgery. Results This study demonstrated no clinically significant difference in cardiovascular variables between the two techniques. Patients had a significantly lower incidence of sore throat, hoarseness, and dysphagia when the lightwand was used for intubation. Conclusion This study suggests that lightwand intubation may decrease the incidence of postoperative sore throat, hoarseness, and dysphagia, thereby potentially increasing satisfaction in surgical patients. Therefore, more frequent use of the lightwand is recommended for endotracheal intubation.

Factors affecting difficult lightwand intubation: a prospective double-blind trial.

Unanticipated difficulties during tracheal intubation are related to perioperative morbidity and mortality, but the success of direct laryngoscopic intubation depends largely on clinician's experience and the upper airway anatomy. The lightwand was introduced as alternative intubation technique, but the indicators of difficult lightwand intubation (DLWI) have not been identified. Accordingly authors conducted this study to identify subject factors that affect DLWI, and to compare these with those of difficult laryngoscopic intubation. Seventy-three healthy subjects requiring tracheal intubation for elective surgery were enrolled. Anatomic factors, such as, body mass index (BMI), Mallampati classification (MC), inter-incisor gap, thyromental distance, neck circumference, extent of head and neck motion, and Cormack-Lehane grade (CL) were determined and evaluated in terms of their abilities to predict DLWI, which was described using intubation time and number of intubation attempts. Multiple regression analyses were performed to identify predictors using a variable selection technique. Only MC and BMI were found to predict DLWI. The weighted sum of time and number of attempts (r2 = 0.854, P = 0.000) was found to be better predictor of DLWI than their product (r2 = 0.734, P = 0.000). Cormack-Lehane grade was not found to be significantly related to DLWI (P = 0.093). Of the anatomic factors examined, only Mallampati classification and body mass index were found to predict difficult lightwand intubation.

Revisited: Haemodynamic Instability and Endocrine Response During Endotracheal Tube-Placement. A Prospective, Randomized Trial Using Topical Lidocaine and a Lightwand

Endotracheal intubation via direct laryngoscopy frequently provokes cardiovascular side-effects. Although us- ing a lightwand intubation device reduces laryngeal stimulation, previous reports indicated a similar stress response com- pared to classical laryngoscopy. We hypothesized that endotracheal tube (ET) placement itself elicits haemodynamic in- stability and that topical anaesthesia can attenuate this response. Methods: 30 patients were randomized to three groups (n = 10 each). After induction of general anaesthesia (fentanyl, etomidate, vecuronium) 5 ml of test solution was applied to laryngo-tracheal structures via a lightwand guided EDGAR- Tube ® . Control group received 5 ml saline 0.9%, group lido 1% 5 ml lidocaine 1%, and group lido 2% 5 ml lidocaine 2%. After 2 minutes of bag-mask ventilation lightwand guided ET placement was performed. Invasive systolic arterial pres- sure (SAP, mmHg), heart rate (HR, bpm) and arterial plasma concentrations of catecholamines ((adr)(nor), pcg ml-) were determined. Results: After ET placement control group patients showed increased HR and SAP (meanHR = 15.3; meanSAP = 45.6) compared to both lido groups (� HR: lido1%/2% = 5.8/3.7; � SAP: lido1%2% = 8.7/13.0). Catecholamine concen- trations also increased only in the control group (mean � (adr) = 101.43; � (nor) = 89.41) but not in lido groups (� (adr): lido1%/2% = -12.93/7.05; � (nor): lido1%/2% = -6.61/-30.55). Effect size calculation indicated strong clinical effects of topical lidocaine for almost all variables (ES > 0.8). Conclusion: ET placement into the non-anaesthesized trachea causes haemodynamic and endocrine stress even if direct laryngoscopy is omitted. Topical anaesthesia effectively reduces this response.

Randomized Study Comparing the Sniffing Position with the Neutral Position for Lightwand Intubation

Background: The sniffing position is recommended for optimal glottic visualization under direct laryngoscopy. However, there is no study assessing whether sniffing position is superior to a neutral position during lightwand-guided intubation. This prospective, randomized study was performed to compare facilitation of lightwand-guided intubation between the sniffing and neutral positions. Methods: The study included 180 patients with normal cervical spines requiring tracheal intubation for elective surgery. Patients were randomly allocated into two groups: neutral or sniffing position. Mallampati class, mouth opening distance, thyromental distance, and laryngeal view grade were measured. A lightwand railroaded with an endotracheal tube was bent 90 o at 5 cm from the distal end for both groups. Time to intubation, success rate and intubation time for the first attempt, hydrodynamic changes, and BIS values were recorded. Results: There were no significant differences in time to intubation, success rate and intubation time of the first trial, hydrodynamic changes, or BIS values between the two positions. Conclusions: Routine use of the sniffing position does not provide any advantage over the neutral position during lightwand-guided intubation. (Korean J Anesthesiol 2008; 54: 25∼9)

Lightwand Intubation For Difficult Airway Patients

Failed laryngoscopy and intubation is associated with potentially severe morbidity. Although there are many alternative tracheal intubation aids, the intubating lightwand has been recommended as a first option in patients with failed or difficult intubation. This report highlights successful lightwand intubation in a case series of patients with known difficult airway.

Lightwand Tracheal Intubation with and without Muscle Relaxation

Lightwand tracheal intubation is a suitable technique for patients who are difficult to intubate but who are receiving effective ventilation. The effect of muscle relaxants on the efficacy of lightwand intubation has not yet been evaluated. The authors conducted a prospective, double-blind, placebo-controlled study to assess the effectiveness and incidence of complications of lightwand tracheal intubation performed during general anesthesia with and without the use of a muscle relaxant in patients with apparently normal airway anatomy. One hundred seventy-six patients who required orotracheal intubation were prospectively included. Anesthesia was administered using propofol (2 mg/kg, then 3 mg . kg (-1). h(-1)) and remifentanil (1 microg/kg, then 0.3 microg . kg(-1) . min(-1)). Patients were randomly assigned to one of two groups (n = 88 for each) to receive rocuronium 0.6 mg/kg or saline intravenously. Lightwand orotracheal intubation (Trachlight; Laerdal Medical Inc., Armonk, NY) was attempted after 3 min. The authors recorded the number of successful intubations, the number of attempts and their duration, and events during the procedure. The failure rate of lightwand intubation was 12% in the placebo group and 2% in the rocuronium group (P = 0.021). Patients in the placebo group received more multiple intubation attempts (P < 0.001), required a greater intubation time (77 +/- 65 vs. 52 +/- 31 s; P = 0.002) and experienced a greater incidence of events during intubation (61 vs. 0%; P < 0.001) than patients in the rocuronium group. The use of muscle relaxants in patients with apparently normal airways is associated with a lower failure rate, decreased intubation time, and fewer attempts when performing lightwand orotracheal intubation.