title: A Comparison Between the Conventional and the Laryngoscope-Assisted Lightwand Intubation Techniques in Patients With Cervical Immobilization: A Prospective Randomized Study.
abstract: Positioning of a lightwand in the midline of the oral cavity can be challenging in patients with cervical immobilization. Direct laryngoscopy may permit the lightwand tip to more easily access the glottic opening. We tested our hypothesis that a laryngoscope-assisted lightwand technique allows more successful endotracheal intubation than does a conventional lightwand approach.
  
  
  
  A total of 162 patients requiring cervical immobilization during intubation for cervical spine surgery were allocated randomly to 2 groups. The conventional lightwand technique (group C, n = 80) or the laryngoscope-assisted lightwand technique (group L, n = 82) was used for endotracheal intubation. In the group L, a Macintosh laryngoscope was inserted into the oral cavity, advanced until the epiglottis tip was visible, but not used to lift the epiglottis tip. The lightwand tip was placed below the epiglottis under direct view of the epiglottis tip. The primary outcome (the initial intubation success rate) and secondary outcomes (intubation time, hemodynamic changes, and postoperative airway complications) were evaluated.
  
  
  
  The initial intubation success rate was significantly lower (75% vs 89%; relative risk [95% confidence interval]: 1.2 [1.0-1.4]; P = .034) in group C than group L. The intubation time (22 ± 13 vs 24 ± 12 seconds; mean difference [98.33% confidence interval]: 2.4 [-2.3 to 7.2]; P = .217) did not differ between groups. Postoperative sore throat score, incidences of hypertension and tachycardia, postoperative oral mucosal bleeding, and hoarseness also did not differ between groups.
  
  
  
  Laryngoscope-assisted lightwand intubation did not increase intubation time, and it increased first attempt intubation rates compared with traditional lightwand intubation in patients requiring cervical immobilization for cervical spine surgery.
authors.affiliation: From the *Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea; †Department of Anesthesiology and Pain Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, Republic of Korea; ‡Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; and §Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
authors.forename: Eugene
authors.initials: E
authors.lastname: Kim
authors.forename: Byung-Gun
authors.initials: BG
authors.lastname: Kim
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Lim
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Jeon
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Hwang
authors.forename: Seo-Yun
authors.initials: SY
authors.lastname: Lee
authors.forename: Hee-Pyoung
authors.initials: HP
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000592:standards; D020704:Laryngoscopes / Q000592:standards; D007828:Laryngoscopy / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012149:Restraint, Physical / Q000379:methods* / Q000592:standards; D016037:Single-Blind Method