Indian Journal of Clinical Anaesthesia


“Light wand- guided nasotracheal intubation in patients with limited mouth opening: a comparison with blind nasal intubation”


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Author Details: Subhash, Vipin Kumar Dhama, Bhagat Singh, Yogesh Manik, Nikhil Dewan

Volume : 3

Issue : 2

Online ISSN : 2394-4994

Print ISSN : 2394-4781

Article First Page : 191

Article End Page : 195


Abstract

Background and objectives: Approximately 1–3% of surgical patients have difficult airways, which accounts for the most important cause of anaesthesia-related morbidity and mortality. The fibreoptic bronchoscope is considered the gold standard for the management of difficult airways. However, blind nasal intubation remains a basic technique in developing countries, especially in remote areas where a Fiberoptic bronchoscope is not always available. The light wand is a simple, cost effective device, and has become a tool widely accepted in airway management under various clinical scenarios, including difficult airways.
The study was conducted to evaluate the efficacy of light wand-guided nasotracheal intubation over blind nasal intubation.
Methods: A total of 60 ASA Grade I & II patients of age 18-60 yrs of Body mass index between 18-25 kg/m2 with limited mouth opening (distance between upper and lower central incisors < 3.0 cm) posted for elective surgeries were divided into two equal groups in a randomized, double-blind fashion.
Blind nasal group 30 patients
Light wand Group: 30 patients
Results: The first attempt and overall success rate of light wand guided nasotracheal intubation was 80% and 90% respectively, significantly higher than blind nasal intubation i.e. 50% and 66.66% respectively (p<0.05). The mean intubation time in light wand group was 103±61 seconds and was 155±73 seconds in blind nasal group (p<0.05). There was significantly better haemodynamic stability and a lower incidence of pharyngalgia in lightwand group.  
Interpretation & Conclusions: The study shows nasotracheal intubation using the light wand to be a more effective and simple approach than blind nasal intubation, with a higher success rate, better haemodynamic stability, and fewer postoperative complications in patients with a known or anticipated difficult airway.

Keywords:
Adult, Blind nasotracheal intubation, Transillumination