title: Efficacy of the transillumination method for appropriate tracheal tube placement in small children: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate whether the transillumination method increased the probability of appropriate tracheal tube (TT) placement compared with the main-stem method.
  
  
  METHODS
  Prospective, randomized, controlled study.
  
  
  METHODS
  Operating room, university hospital.
  
  
  METHODS
  Eighty children <2 years old scheduled for elective surgery undergoing general anesthesia.
  
  
  METHODS
  Trachlight was used for the transillumination method. After intubation, patients were randomly assigned to 1 of 2 groups: (1) deliberate bronchial intubation with subsequent withdrawal of the TT to 2 cm above the carina (main-stem group) or (2) transmitted visual signal from a bright light at the TT tip on the skin at the suprasternal notch after inserting the Trachlight into the TT (transillumination group).
  
  
  METHODS
  The TT tip position was assessed by chest radiograph after the procedure. Appropriate TT placement was defined when the TT tip was located between the sternoclavicular junction and 1 cm above the carina.
  
  
  RESULTS
  Appropriate TT placement was found in 31 (80%) of 39 patients in the transillumination group and 26 (65%) of 40 in the main-stem group. The transillumination method had higher rate of appropriate TT placement than the main-stem method (P = .15; risk ratio, 1.22; 95% confidence interval, 0.93-1.61). Seven patients (18%) had proximal TT placement, and 1 (3%) had distal TT placement in the transillumination group. In the main-stem group, 7 patients (18%) had proximal TT placement, and 7 (18%) had distal TT placement.
  
  
  CONCLUSIONS
  The transillumination method was reliable for appropriate TT placement in small children <2 years old undergoing general anesthesia, although the transillumination method was not found to be better compared with the main-stem method.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: soichi2003@aol.com.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Osaka
authors.affiliation: Department of Anesthesiology, University of Tsukuba Hospital, Tsukuba, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Fujikura
authors.affiliation: Department of Anesthesiology, University of Tsukuba Hospital, Tsukuba, Japan.
authors.forename: Koya
authors.initials: K
authors.lastname: Tabata
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000768:Anesthesia, General / Q000379:methods*; D002675:Child, Preschool; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods*; D011446:Prospective Studies; D014172:Transillumination / Q000379:methods*
keywords: Child; General anesthesia; Intubation; Transillumination