Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.03.002
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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Abstract

Background
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.

Methods
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.

Results
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.

Conclusion
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.

Keywords

Endotracheal intubation,  Elderly patients,  Lightwand

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