title: Lightwand intubation of infants and children.
abstract: OBJECTIVE
  To examine factors contributing to successful lightwand (lighted stylet) intubation of infants and children.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  125 children under age 10 years presenting for elective surgery.
  
  
  METHODS
  Prototype lightwands specifically designed for pediatric patients were used. Intubations were done by anesthesia residents with little or no prior lightwand experience. All attempts were recorded on videotape. In a subgroup of 14 patients, an endoscopic view of the lightwand was also recorded with a flexible nasopharyngoscope.
  
  
  RESULTS
  125 patients with a mean age of 3.0 years (+/- 2.4 years SD; range: 3 weeks to 9 years) were enrolled. 83.2% were intubated using the lightwand, including 75.5% (34 of 45) of infants weighing less than 10 kg. Of the 21 failed intubations, 8 were due to an inappropriately large endotracheal tube, as recognized during direct laryngoscopy; 4 were due to other reasons discussed; and 9 (persistent vallecular or esophageal entry) could not be explained from videotape analysis. Factors contributing to successful intubation included: (1) use of a shoulder roll and slight head extension; (2) conscientious alignment of airway axes; (3) anterior jaw lift to elevate the epiglottis; and (4) gentle handling of the lightwand to avoid displacing soft tissue. Inability to advance the lightwand despite correct glow is caused by entrapment in the vallecula, hang up of the lightwand on the aryepiglottic folds, subglottic narrowing, or vocal cord closure.
  
  
  CONCLUSIONS
  Lightwand intubation in children uses both tactile and visual cues regarding the location of the endotracheal tube tip. Attention to detail results in a high level of success among novice users of the pediatric lightwand. Endoscopic and external videotaping gave us a means of monitoring the progress of mechanical skills among novice users.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University Hospital, Baltimore, MD 21287-5842, USA.
authors.forename: Q A
authors.initials: QA
authors.lastname: Fisher
authors.forename: D E
authors.initials: DE
authors.lastname: Tunkel
mesh_terms: D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D004825:Epiglottis / Q000033:anatomy & histology; D005336:Fiber Optic Technology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D007830:Larynx / Q000033:anatomy & histology; D011446:Prospective Studies; D014743:Videotape Recording