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

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

doi:10.1016/j.bjane.2021.03.002

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Brazilian Journal of Anesthesiology

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Sumário

CLINICAL RESEARCH • para Braz. J. Anesthesiol. 71 (4) • Jul-Aug 2021 • https://doi.org/10.1016/j.bjane.2021.03.002 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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 throat 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

	Group M (n = 50)	Group G (n = 50)	Group F (n = 50)	Group L (n = 50)
Age (y)	73.44 ± 5.17	72.66 ± 4.67	72.94 ± 5.19	73.00 ± 5.60
Sex (M/F)	23/27	25/25	24/26	21/29
BMI (kg.m^-2)	23 ± 3.9	22 ± 2.7	23 ± 2.1	23 ± 2.8
ASA class 1/2	41/9	44/6	42/8	46/4

Group	Pre- induction (T₀)	Pre-intubation (T₁)	Post-intubation (T₂)	Minutes post-intubation
Group	Pre- induction (T₀)	Pre-intubation (T₁)	Post-intubation (T₂)	1 (T₃)	3 (T₄)	5 (T₅)
Group M
SBP (mmHg)	132 ± 10.12	113 ± 15.72	135 ± 9.36	124 ± 13.69	115 ± 12.91	109 ± 15.38
DBP (mmHg)	86 ± 10.12	73 ± 13.29	93 ± 14.12	87 ± 14.66	82 ± 15.39	75 ± 13.34
HR (bpm)	75 ± 12.54	71 ± 12.59	92 ± 13.92	84 ± 10.22	82 ± 11.38	80 ± 10.29
Group G
SBP (mmHg)	129 ± 15.38	112 ± 12.72	133 ± 16.29	125 ± 17.48	116 ± 16.25	110 ± 18.21
DBP (mmHg)	84 ± 14.63	75 ± 15.27	92 ± 14.61	85 ± 12.42	80 ± 13.21	74 ± 15.73
HR (bpm)	74 ± 13.51	71 ± 10.63	93 ± 10.91	82 ± 9.41	82 ± 10.43	81 ± 11.40
Group F
SBP (mmHg)	133 ± 14.29	112 ± 16.94	132 ± 12.40	118 ± 17.25	113 ± 14.90	109 ± 16.30
DBP (mmHg)	83 ± 13.53	74 ± 14.37	91 ± 12.62	86 ± 14.85	81 ± 15.84	73 ± 14.39
HR (bpm)	76 ± 12.62	70 ± 13.82	95 ± 11.47	81 ± 9.92	80 ± 12.34	77 ± 13.24
Group L
SBP (mmHg)	129 ± 16.39	114 ± 13.51	116 ± 14.32^a a p < 0.05 compared to Group M, G and F (Only intergroup significances are showed).	113 ± 16.25	110 ± 14.38	107 ± 15.23
DBP (mmHg)	84 ± 15.57	75 ± 14.38	80 ± 15.41^a a p < 0.05 compared to Group M, G and F (Only intergroup significances are showed).	79 ± 16.25	76 ± 15.39	73 ± 16.18
HR (bpm)	77 ± 13.05	74 ± 11.60	82 ± 12.58^a a p < 0.05 compared to Group M, G and F (Only intergroup significances are showed).	80 ± 9.03	79 ± 12.67	78 ± 12.91

	Group M		Group G		Group F		Group L
	E (nmoL.L^-1)	NE (nmoL.L^-1)	E (nmoL.L^-1)	NE (nmoL.L^-1)	E (nmoL.L^-1)	NE (nmoL.L^-1)	E (nmoL.L^-1)	NE (nmoL.L^-1)
Pre-induction	0.191 ± 0.07	1.63 ± 0.35	0.228 ± 0.04	1.59 ± 0.31	0.211 ± 0.07	1.69 ± 0.48	0.205 ± 0.09	1.55 ± 0.32
Pre-intubation	0.124 ± 0.05	1.14 ± 0.41	0.136 ± 0.09	1.03 ± 0.42	0.118 ± 0.04	1.21 ± 0.30	0.137 ± 0.06	1.13 ± 0.27
Post-intubation	0.091 ± 0.008	1.43 ± 0.37	0.083 ± 0.003	1.49 ± 0.26	0.092 ± 0.005	1.19 ± 0.31^a a p < 0.05 compared to Group M, G and F (Only intergroup significances are showed).	0. 101 ± 0.004	1.10 ± 0.37^a a p < 0.05 compared to Group M, G and F (Only intergroup significances are showed).

	Group M	Group G	Group F	Group L
Success rate at first time	10/40 (80%)	11/39 (82%)	5/45 (90%)^a a p < 0.05 Group F or L compared to Group M or G (Only intergroup significances are showed).	3/47 (94%)^a a p < 0.05 Group F or L compared to Group M or G (Only intergroup significances are showed).
Duration time	46.24 ± 14.35	39.71 ± 11.94	41.39 ± 13.28	25.47 ± 11.58^a a p < 0.05 Group F or L compared to Group M or G (Only intergroup significances are showed).
Hoarseness	4/46 (8%)	3/47 (6%)	0^a a p < 0.05 Group F or L compared to Group M or G (Only intergroup significances are showed).	0^a a p < 0.05 Group F or L compared to Group M or G (Only intergroup significances are showed).
Sore throat	12/38 (24%)	7/43 (12%)	2/48 (4%)^a a p < 0.05 Group F or L compared to Group M or G (Only intergroup significances are showed).	3/47 (6%)^a a p < 0.05 Group F or L compared to Group M or G (Only intergroup significances are showed).
Loss of teeth	5/45 (10%)	6/44 (12%)	5/45 (10%)	0^a a p < 0.05 Group F or L compared to Group M or G (Only intergroup significances are showed).
Dental or gum injury	7/43 (14%)	5/45 (10%)	4/46 (8%)^a a p < 0.05 Group F or L compared to Group M or G (Only intergroup significances are showed).	0^a a p < 0.05 Group F or L compared to Group M or G (Only intergroup significances are showed).

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] * Corresponding author.E-mail: liyuanhai-1@163.com (Y. Li).