Comparison of the lightwand technique with direct laryngoscopy for awake endotracheal intubation in emergency cases.

STUDY

OBJECTIVE

To clarify the efficacy of the lightwand technique compared with that of the conventional laryngoscopic technique for awake endotracheal intubation in patients requiring emergency surgery.

DESIGN

Prospective clinical study.

SETTING

Anesthesia department of a teaching hospital.

PATIENTS: 60 ASA physical status IE patients undergoing emergency surgery.

INTERVENTIONS: Awake intubations using the lightwand technique (LW group) and a laryngoscope (LS group) were performed with conscious sedation with midazolam and fentanyl.

MEASUREMENTS AND MAIN

RESULTS

Time to intubation and number of intubation attempts in the LW group were significantly shorter and smaller, respectively, than those in the LS group (p < 0.01). Fewer LW group patients complained of a sore throat than in the LS group. DeltaP [changes from "before intubation" to "immediately after intubation" in mean arterial pressure (MAP)] in the LS group was significantly larger than that in the LW group (p < 0.05), although doses of sedatives in the two groups were not different. No hypoxemia or apnea associated with sedation was found in either of the groups.

CONCLUSIONS

The lightwand technique produces less magnitude of stress following tracheal intubation than does the conventional laryngoscopic technique for awake intubation. Lightwand-assisted awake intubation is thought to be a useful means for induction of anesthesia in cases of emergency surgery.