Evaluation of lightwand-guided endotracheal intubation for patients with missing or no teeth: a randomized controlled study
Avaliação da intubação endotraqueal guiada por Lightwand para pacientes com dentes ausentes ou sem dentes: Um estudo controlado randomizado
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.
Justificativa: Dentes não saudáveis podem afetar seriamente a saúde geral e aumentar o risco de morte em pessoas idosas. Não houve confirmação de qual dispositivo é mais eficaz para pacientes idosos com perda dentária. Portanto, comparamos quatro dispositivos de intubação em pacientes idosos com perda dentária parcial e total, com o objetivo de reduzir o risco durante a anestesia. Metodologia: Duzentos pacientes foram randomizados para serem submetidos à intubação traqueal com o laringoscópio Macintosh, o Glidescope, o broncoscópio de fibra ótica ou o Lightwand como parte da anestesia geral. Foi utilizado um protocolo unificado de medicamentos anestésicos. A FC e a PA foram mensuradas em T0, T1, T2, T3, T4 e T5. Amostras de sangue de catecolaminas (epinefrina e norepinefrina) foram coletadas em T0, T1 e T2. O tempo de intubação e as complicações pós-operatórias, incluindo danos e perdas dentárias, foram registrados. Resultados: Flutuações reduzidas na FC, PAD e PAS foram observadas no grupo Lightwand. O tempo de intubação foi significativamente menor no grupo Lightwand (p <0,05). Não houve diferença estatisticamente significativa entre os grupos nos níveis de epinefrina, mas os níveis de norepinefrina foram menos voláteis nos grupos de broncoscópio de fibra óptica e do Lightwand. Menos pacientes no grupo do Lightwand experimentaram danos dentários e outras complicações pós- -operatórias do que nos outros três grupos. Embora a maior taxa de sucesso na primeira tentativa tenha sido tão alta quanto no grupo do broncoscópio de fibra óptica, menor tempo de intubação foi observado apenas no grupo Lightwand. Conclusão: O Lightwand oferece menos estimulação hemodinâmica que o laringoscópio Macintosh, o Glidescope e de fibra ótica. Por ter o menor tempo de intubação, o Lightwand causou menos danos aos dentes e à garganta de pacientes idosos. Nossos achados mostraram que a intubação traqueal com Lightwand foi vantajosa para prevenir respostas ao estresse cardiovascular com tempos curtos de intubação e menos complicações pós-operatórias.
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