Kaohsiung Journal of Medical Sciences
Volume 23, Issue 10 , Pages 504-510, October 2007

Lightwand-Guided Endotracheal Intubation Performed by the Nondominant Hand is Feasible

  • Yi-Wei Kuo

      Affiliations

    • Departments of Anesthesiology and Kaohsiung Medical University, Kaohsiung, Tainan, Taiwan
    • ,
  • Mu-Ken Yen

      Affiliations

    • Departments of Anesthesiology and Kaohsiung Medical University, Kaohsiung, Tainan, Taiwan
    • ,
  • Kuang-I Cheng

      Affiliations

    • Department of Anesthesiology, Municipal Hsiao-Kang Hospital, Kaohsiung, Tainan, Taiwan
    • School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Tainan, Taiwan
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr Kuang-I Cheng, Department of Anesthesiology, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
    • ,
  • Chao-Shuan Tang

      Affiliations

    • Departments of Anesthesiology and Kaohsiung Medical University, Kaohsiung, Tainan, Taiwan
    • School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Tainan, Taiwan
    • ,
  • Siu-Wah Chau

      Affiliations

    • Departments of Anesthesiology and Kaohsiung Medical University, Kaohsiung, Tainan, Taiwan
    • School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Tainan, Taiwan
    • ,
  • Ming-Fung Hou

      Affiliations

    • School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Tainan, Taiwan
    • Department of General Surgery, Kaohsiung Medical University, Kaohsiung, Tainan, Taiwan
    • ,
  • Jhi-Jong Wang

      Affiliations

    • Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan
    • ,
  • Shu-Fen Lin

      Affiliations

    • Departments of Anesthesiology and Kaohsiung Medical University, Kaohsiung, Tainan, Taiwan

Received 25 October 2006; accepted 5 February 2007.

Article Outline

The aim of this study was to evaluate the efficiency of lightwand-guided endotracheal intubation (LWEI) performed using either the right (dominant) or left (nondominant) hand. Two hundred and forty patients aged 21–64 years, with a Mallampati airway classification grade of I—II and undergoing endotracheal intubation under general anesthesia, were enrolled in this randomized and controlled study. Induction of anesthesia was initiated by intravenous administration of fentanyl (2 mg/kg) and thiopentone (5mg/kg), and tracheal intubation was facilitated by intravenous atracurium (0.5 mg/kg). In the direct-vision laryngoscope group (group D; n = 80), the intubator held the laryngoscope in the left hand and inserted the endotracheal tube (ETT) into the glottic opening with the right hand. In the group in which LWEI was performed with the right hand (group R; n = 80), the intubator lifted the patients' jaws with the left hand and inserted the ETT-LW unit into the glottic openings with the right hand. On the contrary, in the group in which LWEI was performed with the left hand (group L; n = 80), the intubator lifted the jaws with the right hand and inserted the ETT-LW unit with the left hand. Data including total intubation time, the number of intubation attempts, hemodynamic changes during intubation, and side effects following intubation, were collected. Regardless of whether lightwand manipulation was performed with the left hand (group L; 11.4 ± 9.3 s) or the right-hand (group R; 12.4 ± 9.2 s), less time was consumed in the LWEI groups than in the laryngoscope group (group D; 17.9 ± 9.9s) (p < 0.001). All three groups obtained success rates > 95% on their first intubation attempts. The changes in mean arterial blood pressure and heart rate were similar among the three groups. A higher incidence of intubation-related oral injury and ventricular premature contractions (VPC) was found in group D compared with groups L and R (oral injury: group D 8.5%, group L 1.3%, group R 0%, p = 0.005; VPC: group D 16.3%, group L 5%, group R 7.5%, p = 0.04). We concluded that LWEI performed by either dominant or nondominant hands resulted in similar efficiency, and could be a suitable alternative to traditional laryngoscopy. It is both feasible and logical for an experienced anesthesiologist to use the nondominant hand to perform LWEI.

Key Words:  endotracheal tube , lightwand , nondominant hand

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References 

  1. Hung OR , Pytka S , Morris I , et al.   Clinical trial of a new lightwand device (Trachlight) to intubate the trachea . Anesthesiology . 1995;83:509–514
  2. Hung OR , Pytka S , Morris I , et al.   Lightwand intubation: II—Clinical trial of a new lightwand for tracheal intubation in patients with difficult airways . Can J Anaesth . 1995;42:826–830
  3. Robinson K , Donaghy K , Katz R . Inverse intubation in air medical transport . Air Med J . 2004;23:40–43
  4. Langeron O , Lenfant F , Aubrun F , et al.   Assessment of a new light guide (Trachlight) for tracheal intubation . Ann Fr Anesth Reanim . 1997;16:229–233 [In French]
  5. Stone DJ , Gal TJ . Airway management . In:  Miller RD editors. Anesthesia . 5th edition. New York: Churchill Livingstone; 2000;p. 1414–1448
  6. Kanaide M , Fukusaki M , Tamura S , et al.   Hemodynamic and catecholamine responses during tracheal intubation using a lightwand device (Trachlight) in elderly patients with hypertension . J Anesth . 2003;17:161–165
  7. Takahashi S , Mizutani T , Miyabe M , Toyooka H . Hemodynamic responses to tracheal intubation with laryngoscope versus lightwand intubating device (Trachlight) in adults with normal airway . Anesth Analg . 2002;95:480–484
  8. Nishikawa K , Kawana S , Namiki A . Comparison of the lightwand technique with direct laryngoscopy for awake endotracheal intubation in emergency cases . J Clin Anesth . 2001;13:259–263
  9. Nishikawa K , Omote K , Kawana S , Namiki A . A comparison of hemodynamic changes after endotracheal intubation by using the lightwand device and the laryngoscope in normotensive and hypertensive patients . Anesth Analg . 2000;90:1203–1207
  10. Kihara S , Brimacombe J , Yaguchi Y , et al.   Hemodynamic responses among three tracheal intubation devices in normotensive and hypertensive patients . Anesth Analg . 2003;96:890–895
  11. Kageyama T , Yaguchi S , Metori Y , et al.   Visual results and complications of temporal incision phacoemulsification performed with the non-dominant left hand by junior ophthalmologists . Br J Ophthalmol . 2002;86:1222–1224
  12. Orbak R , Tezel A , Canakci V , Tan U . Right- and left-handed dentists using right- and left-sided dental chairs in treatment of calculus . Int J Neurosci . 2002;112:15–30
  13. Andree ME , Maitra KK . Intermanual transfer of a new writing occupation in young adults without disability . Occup Ther Int . 2002;9:41–56
  14. Hirabayashi Y , Hiruta M , Kawakami T , et al.   Effects of lightwand (Trachlight) compared with direct laryngoscopy on circulatory responses to tracheal intubation . Br J Anaesth . 1998;81:253–255
  15. Nishiyama T , Matsukawa T , Hanaoka K . Optimal length and angle of a new lightwand device (Trachlight) . J Clin Anesth . 1999;11:332–335
  16. Chen TH , Tsai SK , Lin CJ , et al.   Does the suggested lightwand bent length fit every patient? The relation between bent length and patient's thyroid prominence-to-mandibular angle distance . Anesthesiology . 2003;98:1070–1076

PII: S1607-551X(08)70008-1

doi:10.1016/S1607-551X(08)70008-1

Kaohsiung Journal of Medical Sciences
Volume 23, Issue 10 , Pages 504-510, October 2007

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