A Comparison Between A Modified Lightwand And The Macintosh Laryngoscope During Orotracheal Intubation: A Prospective, Randomised, Cross-Over Trail

ObjectiveTo investigate the efficiency and safety of the modified lightwand guided orotrachealintubation during routine airway management by means of comparing the intubation time,the success rate of tracheal intubation, complications of tracheal intubation and thehaemodynamic responses during orotracheal intubation with the modified lightwand andthe Macintosh laryngoscope.MethodsFifty patients of ASA physical status I-II, aged20-65years, scheduled for electivesurgery under general anesthesia with orotracheal intubation were recruited into this study.All patients characteristics and preoperative airway assessment (thyromental distance,inter-incisor distance, Mallampati class and mobility of the cervical spine) were recordedbefore tracheal intubation. After anesthesia induction, we inserted a Macintoshlaryngoscope and the modified lightwand in turn. Cormack-Lehane grade of laryngeal view,intubation time, the number of intubation attempts, the success rate of tracheal intubation,complications of tracheal intubation, the haemodynamic response and the changes of pulseoxygen saturation were recorded during orotracheal intubation.Results1. The total intubation time with the modified lightwand was significantly shorter (mean± standard deviation:8.53±3.15seconds) than with the Macintosh laryngoscope (18.39±9.49seconds)(P<0.01).2. The exposure time of glottis with the Macintosh laryngoscope (13.68±6.47seconds) wassignificantly longer than with the modified lightwand (5.66±2.66seconds)(P<0.01), theintubation time of tracheal tube with the modified lightwand was significantly shorter(2.86±0.77seconds) than with the Macintosh laryngoscope (4.50±3.79seconds)(P<0.01).3. The rate of successful intubation at first attempt with the modified lightwand and theMacintosh laryngoscope was100%and99%respectively, the total success rate was100%respectively (P>0.05).4. There was no significant difference between the two devices in complications of trachealintubation (P>0.05).5. Mean arterial pressure and heart rate significantly increased after tracheal intubation1min in both of two devices (P<0.05). The changes of mean arterial pressure and heart ratewere more significant with the Macintosh laryngoscope than with the modified lightwand(P<0.05). SpO2was maintained above99%during orotracheal intubation in both of twodevices.6. There was a significant correlation between Mallampati classification and the totalintubation time of the Macintosh laryngoscope (P<0.01).The total intubation time of themodified lightwand in Mallampati classification Ⅱand Ⅲ were significantly longer thanin Mallampati classificationⅠ(P<0.01); There was no significant difference betweenMallampati classificationⅡ and Ⅲ in the total intubation time of the modified lightwand(P>0.05).7. There was a significant correlation between Cormack–Lehane grade and the totalintubation time of the Macintosh laryngoscope and the modified lightwand (P<0.01).ConclusionThe modified lightwand is an effective, feasible and safe device for routine airwaymanagement.