The Role of the Lightwand

Abstract

The lightwand has been used in airway management for more than five decades and was first described to assist direct laryngoscopic orotracheal intubation in 1957 [1]. Soon after, in 1959, a study reported the successful use of the lightwand, based on the principle of transillumination of the throat, to facilitate nasotracheal intubation in 29 of 30 patients with severe trismus [2]. The authors noted three concerns that are still valid today: the need for a dark room to appreciate transillumination in the neck, the difficulty in transilluminating patients with thick necks, and the risk of thermal injury [2]. The lightwand was first used as a commercial stylet, later that year [3]. However, the initial interest in the device soon waned, probably because of the difficulty in transillumination of the light through red rubber tracheal tubes that were being used at that time. The lightwand regained popularity with the advent of clear, plastic tracheal tubes in 1985. It was reported to be useful in accurately determining the position of tracheal tubes, with 96 % accuracy, in less than 5 s [4] and was used to facilitate difficult tracheal intubation in adults [5]. Currently, many lightwand devices (e.g., Flexilum™, Concept Corporation, Clearwater FL; Surch Lite™, Aaron Medical, Clearwater FL and Tubestat™, Xomed, Jackonville FL) are available from different manufacturers (Fig. 10.1). The Trachlight™ (Laerdal, Wappingers Falls, NY) was the most widely used and studied of these devices (Fig. 10.2); however, the manufacturer discontinued this product in 2009 due to declining sales.