The Difficult Airway in Adult Critical Care

Gavin G. Lavery, MD, FCARSCI, MB, BCh, BAO; Brian V. McCloskey, MB, BCh, FRCA, FFARCSI, MRCP


Crit Care Med. 2008;36(7):2163-2173. 

In This Article

Lighted Stylet

The lighted stylet (light wand) is a malleable fiberoptic light source on which an ETT can be mounted and subsequently railroaded into the trachea when the light source has passed beyond the glottis.[107] It facilitates blind tracheal intubation by distinguishing the tracheal lumen from the (more posterior) esophagus as a result of the greater intensity of light visible through anterior soft tissues of the neck as the light source passes beyond the vocal cords.[108] During routine general anesthesia, intubation time and failure rate with light wand-assisted intubation is similar to direct laryngoscopy[109] and in a large North American survey, it was the most popular alternative airway device in the difficult intubation scenario.[110] It may be used in conjunction with the laryngeal mask airway or as part of a combined technique with a fiberoptic scope.[111,112] A potential disadvantage is the need for low ambient light, which may not be desirable (or easily achieved) in a critical care setting. Light wand devices may be contraindicated in patients with known abnormal upper airway anatomy and those in whom detectable transillumination is unlikely to be adequately achieved.[107]


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