A comparative study of tracheal intubation using an intubating laryngeal mask (Fastrach) alone or together with a lightwand (Trachlight).

STUDY OBJECTIVE: To determine if the Trachlight lightwand can facilitate Fastrach intubation by guiding the tip of the endotracheal tube into the trachea.

DESIGN: Open-label, prospective, randomized, comparative study.

SETTING: General operating suites of a tertiary teaching hospital.

PATIENTS: 172 elective surgical patients requiring general anesthesia with endotracheal intubation.

INTERVENTIONS: With general anesthesia, the Fastrach, which is a new intubating laryngeal mask airway, was inserted into the oropharynx. Ventilation was ensured before the insertion of an endotracheal tube via the Fastrach. Tracheal intubation was then performed randomly (coin toss) using either the endotracheal tube alone (Fastrach group), or endotracheal tube with the Trachlight, a lightwand (Fastrach/Trachlight group). The time to place the Fastrach and endotracheal tube, to remove the Fastrach, and the total time to intubate were recorded. The number of attempts, failures, trauma, sore throats, and hemodynamic changes were also recorded. Data were analyzed using unpaired t-test, ANOVA with repeated measures, or Chi-squares contingency table where appropriate.

MEASUREMENTS AND MAIN RESULTS: Although there were no differences in the times to place the Fastrach, and endotracheal tube, the hemodynamic changes, and postoperative complications, there were significantly more attempts and failures in the Fastrach group compared to the Fastrach/Trachlight group. There were no differences in the incidence of sore throat and trauma in between the groups.

CONCLUSIONS: Although tracheal intubation is effective using a Fastrach alone (76% success rate), it is more effective when the Fastrach is used in conjunction with the Trachlight (95%). These results suggest that the lightwand is a useful adjunct for Fastrach intubation. However, the role of Fastrach intubation together with the Trachlight in the management of patients with a potential difficult airway remains to be determined.