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Anesth Analg 2003;96:627-628
© 2003 International Anesthesia Research Society

LETTERS TO THE EDITOR

Yet Another Bend in the Wand!

Wasimul Huda, MBBS, Rashid M. Kahn, MD, Moied Ahmad, MD, and Manpreet Singh, MBBS

Department of Anesthesiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

To the Editor:

The use of light wand/TrachlightTM (TL) has been extensively reviewed in patients with routine and difficult laryngoscopic intubation (1,2). However, no mention has been made in the anesthetic literature whether protruded upper frontal incisors (buckteeth) appear to influence the ease and success of intubation with the TL.

In our experience with the device for the last 4 years in patients with buckteeth (Fig. 1), we found a hindrance by the teeth while the endotracheal tube-TrachlightTM (ETT-TL) assembly was manipulated in the patient’s mouth to direct the TL tip into the glottic opening. The protruding teeth were in the way while performing a rocking motion along an imaginary arc to advance the device, as has been described for the standard TL-assisted intubation technique and also when the obstructing epiglottis is to be circumvented using a scooping movement of the ETT-TL assembly (1,2).



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  		Figure 1. A patient with protruded upper frontal incisors (buckteeth).

 
To overcome this problem, we added another bend in the ETT-TL assembly proximal to the already made "hockey stick" bend (Fig. 2). The bend was made such that it would coincide with the protruded teeth when the ETT-TL assembly was placed along the patient’s profile. With the bend at the level of the buckteeth, we found a distinct ease of maneuverability, especially while performing the rocking movements with the ETT–TL assembly. Proper lubrication of the ETT and the internal stylet ensured the easy retraction of the stylet while performing endotracheal intubation.



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  		Figure 2. The second bend (at the level of the arrow) in the endotracheal tube-TrachlightTM assembly proximal to the already made "hockey stick" bend.

 
References

  1. Davis L, Cook-Sather SD, Schreiner MS. Lighted stylet intubation: a review. Anesth Analg 2000; 90: 745–56.[Free Full Text]
  2. Agro F, Hung OR, Cataldo R, et al. Lightwand intubation using the TrachlightTM: a brief review of current knowledge. Can J Anaesth 2001; 48: 592–9.[Web of Science][Medline]



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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2003 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press