Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

Evaluation of lightwand-guided endotracheal intubation for patients with missing or no teeth: a randomized controlled study

Xiaoyan Ge, Wei Liu, Ziting Zhang, Fenglei Xie, Tengfei Zhao, Yuanhai Li

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Unhealthy teeth can seriously affect general health and increase the risk of death in elderly people. There has been no confirmation of which device is most effective for elderly patients with teeth loss. Therefore, we compared four intubation devices in elderly patients with partial and total tooth loss, aiming to reduce risk during anesthesia.

Two hundred patients were randomized to undergo tracheal intubation with the Macintosh laryngoscope, the Glidescope, the Fiberoptic bronchoscope or the Lightwand as part of general anesthesia. A unified protocol of anesthetic medications was used. HR and BP were measured at T0, T1, T2, T3, T4 and T5. Catecholamine (epinephrine and norepinephrine) blood samples were drawn at T0, T1 and T2. Intubation time and postoperative complications, including dental damage and losses, were recorded.

Reduced fluctuations in HR, DBP and SBP were observed in the Lightwand group. Intubation time was significantly shorter in the Lightwand group (p < 0.05). There was no statistically significant difference between the groups in epinephrine levels, but norepinephrine levels were less volatile in the Fiberoptic bronchoscope and Lightwand groups. Fewer patients in the Lightwand group experienced dental damage and other postoperative complications than in the other three groups. Although a higher success rate on the first attempt was as high as in the Fiberoptic bronchoscope group, shorter intubation time was observed only in the Lightwand group.

The Lightwand offers less hemodynamic stimulation than the Macintosh laryngoscope, Glidescope and Fiberoptic bronchoscope. Because it had the shortest intubation time, the Lightwand caused the least damage to the teeth and throats of elderly patients. Our findings showed that tracheal intubation with the Lightwand was advantageous for preventing cardiovascular stress responses with short intubation times and fewer postoperative complications.


Endotracheal intubation,  Elderly patients,  Lightwand


[1] X.-W. Liu, Y. Zi, L.-B. Xiang, et al. Total hip arthroplasty: areview of advances, advantages and limitations Int J Clin Exp Med, 8 (2015), pp. 27-36

[2] E.J. Fox, G.S. Sklar, C.H. Hill, et al. Complications related to the pressor response to endotracheal intubation Anesthesiology, 47 (1977), pp. 524-525

[3] V. McCredie, A.S. Alali, D.C. Scales, et al. Effect of early versus late tracheostomy or prolonged intubation in critically ill patients with acute brain injury: a systematic review and meta-analysis Neurocrit Care, 26 (2017), pp. 14-25

[4] E.P. McCoy, R.K. Mirakhur, B.V. McCloskey A comparison of the stress-response to laryngoscopy – the macintosh versus the mccoy blade Anaesthesia, 50 (1995), pp. 943-946

[5] NM Cass Medicolegal claims against anaesthetists: a 20 year study Anaesth Intensive Care, 32 (2004), pp. 47-58

[6] T.M. Cook, S. Scott, R. Mihai Litigation related to airway and respiratory complications of anaesthesia: an analysis of claims against the NHS in England 1995-2007 Anaesthesia, 65 (2010), pp. 556-563

[7] J. Mourao, J. Neto, C. Luis, et al. Dental injury after conventional direct laryngoscopy: a prospective observational study Anaesthesia, 68 (2013), pp. 1059-1065

[8] I. Appollonio, C. Carabellese, A. Frattola, et al. Influence of dental status on dietary intake and survival in community-dwelling elderly subjects Age Ageing, 26 (1997), pp. 445-456

[9] P. Hamalainen, J.H. Meurman, M. Keskinen, et al. Relationship between dental health and 10-year mortality in a cohort of community-dwelling elderly people Eur J Oral Sci, 111 (2003), pp. 291-296

[10] T. Osterberg, D. Mellstrom, V. Sundh Dental health and functional ageing. A study of 70-year-old people Community Dent Oral Epidemiol, 18 (1990), pp. 313-318

[11] Y. Shimazaki, I. Soh, T. Saito, et al. Influence of dentition status on physical disability mental impairment, and mortality in institutionalized elderly people J Dent Res, 80 (2001), pp. 340-345

[12] R. Lopez, P.C. Smith, G. Goestemeyer, et al. Ageing, dental caries and periodontal diseases J Clin Periodontol, 44 (2017), pp. S145-S152

[13] J.E. Smith, A.A. Mackenzie, S.S. Sanghera, et al. Cardiovascular effects of fibrescope-guided nasotracheal intubation Anaesthesia, 44 (1989), pp. 907-910

[14] S.R. Finfer, S.I. MacKenzie, J.M. Saddler, et al. Cardiovascular responses to tracheal intubation: a comparison of direct laryngoscopy and fibreoptic intubation Anaesth Intensive Care, 17 (1989), pp. 44-48

[15] S.R. Lewis, A.R. Butler, J. Parker, et al. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review Br J Anaesth, 119 (2017), pp. 369-383

[16] T. Pernerstorfer, P. Krafft, R.D. Fitzgerald, et al. Stress-response to tracheal intubation – direct laryngoscopy compared with blind oral intubation Anaesthesia, 50 (1995), pp. 17-22

[17] S. Mao, X. Du, J. Ma, et al. A comparison between laryngeal mask airway and endotracheal intubation for anaesthesia in adult patients undergoing NUSS procedure J Thorac Dis, 10 (2018), pp. 3216-3224

[18] U.M. Hodges, D. Oflaherty, A.P. Adams Tracheal intubation in a mannikin – comparison of the belscope with the macintosh laryngoscope Br J Anaesth, 71 (1993), pp. 905-907

[19] J.B. Lascarrou, J. Boisrame-Helms, A. Bailly, et al. Video Laryngoscopy vs direct laryngoscopy on successful first-pass orotracheal intubation among ICU patients a randomized clinical trial JAMA, 317 (2017), pp. 483-493

[20] T.P. Turkstra, R.A. Craen, D.M. Pelz, et al. Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope Anesth Analg, 101 (2005), pp. 910-915

[21] W.J. Jeon, J.H. Shim, S.Y. Cho, et al. Stylet- or forceps-guided tube exchanger to facilitate GlideScope (R) intubation in simulated difficult intubations – a randomised controlled trial Anaesthesia, 68 (2013), pp. 585-590

[22] H Li, W Wang, Y-P Lu, et al. Evaluation of endotracheal intubation with a flexible fiberoptic bronchoscope in lateral patient positioning: a prospective randomized controlled trial Chin Med J, 129 (2016), pp. 2045-2049

[23] E.Y. Park, J.Y. Kim, J.S. Lee Tracheal intubation using the Airtraq (R): a comparison with the lightwand Anaesthesia, 65 (2010), pp. 729-732

[24] C. Frerk, V.S. Mitchell, A.F. McNarry, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults Br J Anaesth, 115 (2015), pp. 827-848

[25] D.S. Goldstein, G. Feuerstein, JL Izzo Jr., et al. Validity and reliability of liquid chromatography with electrochemical detection for measuring plasma levels of norepinephrine and epinephrine in man Life Sci, 28 (1981), pp. 467-475

[26] K. Takeuchi, T. Ohara, M. Furuta, et al. Tooth loss and risk of dementia in the community: the hisayama study J Am Geriatr Soc, 65 (2017), pp. e95-e100

[27] P. Holm-Pedersen, K. Avlund, D.E. Morse, et al. Dental caries, periodontal disease, and cardiac arrhythmias in community-dwelling older persons aged 80 and older: Is there a link? J Am Geriatr Soc, 53 (2005), pp. 430-437

[28] S.M. Compton, D. Clark, S. Chan, et al. Dental implants in the elderly population: a long-term follow-up Int J Oral Maxillofac Implants, 32 (2017), pp. 164-170

[29] N. Siddiqui, R. Katznelson, Z. Friedman Heart rate/blood pressure response and airway morbidity following tracheal intubation with direct laryngoscopy, GlideScope and Trachlight: a randomized control trial Eur J Anaesthesiol, 26 (2009), pp. 740-745

[30] K.H. Yang, C.H. Jeong, K.C. Song, et al. Comparison between Glidescope and Lightwand for tracheal intubation in patients with a simulated difficult airway Korean J Anesthesiol, 68 (2015), pp. 22-26

[31] D. Altun, A. Ali, E. Camci, et al. Haemodynamic response to four different laryngoscopes Turk J Anaesthesiol Reanim, 46 (2018), pp. 434-440

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