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Lighted Stylet Assisted Tracheal Intubation

Background

Various types of stylets are commonly available as adjuncts to endotracheal intubation, including the traditional malleable stylet, the gum elastic bougie (see the first video below), optical stylets, and lighted stylets (see the second video below). This article discusses the use of lighted stylets for tracheal intubation.

Tracheal intubation (gum elastic bougie). Video courtesy of Therese Canares, MD, and Jonathan Valente, MD, Rhode Island Hospital, Brown University.

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Tracheal intubation (lighted stylet). Video courtesy of Therese Canares, MD, and Jonathan Valente, MD, Rhode Island Hospital, Brown University.

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Lighted stylets available include Light Wand (Vital Signs Inc, Totowa, NJ), Trachlight (Laerdal Medical, Wappingers Falls, NY), Tube Stat lighted stylet (Xomed, Jacksonville, FL), and others.
 These devices rely on the principle of transillumination of the soft tissues of the neck. The light serves to guide the tube into the larynx; direct visualization of the glottis is not required for successful use.

Intubation under direct vision may be difficult or impossible in 1-3% of surgical patients and 0.05-3.5% of obstetric patients.
 Light-guided intubation using transillumination has proven to be simple and effective. When the tip of the lightwand is placed inside the glottis, a bright glow can be seen in the anterior soft tissue of the neck. In contrast, if the lightwand is placed in the esophagus, no transillumination is observed.

Benefits of light-guided tracheal intubation include utility in obstructed conditions, low acquisition costs, and disposable components that eliminate the need for disinfection of the equipment. A distinct disadvantage is that room lights must be dimmed during the procedure. The procedure also requires a fair amount of user experience.

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