Lightwand Intubation: Residents Trained on Powerful, Low-Tech Technique

Stories and Features

Wake Forest's "Airway First" approach to Anesthesiology training requires their residents to learn how to use several different intubation devices. One of these, the lightwand, is an uncommon but particularly resourceful tool for anesthesiologists. While standard intubation tools like the laryngoscope have a very high success rate, they do fail in some situations. "The lightwand is good when things are bad," says John E. Reynolds MD, Associate Professor of Anesthesiology and Neurosurgery, and the Program Director of the Anesthesiology Residency. "It works in a helicopter, in the dark, on the ground, when the neck is immobile, or the mouth is full of blood. It doesn't require electricity, and you can take it with you wherever you go."

Low-Tech and Powerful

A low-tech technique with obvious military utility, lightwand intubation is not typically taught at civilian institutions. Wake Forest trains all of their anesthesiology residents in its use, however, so they can be prepared for the unexpected. Patients who are difficult to intubate make up just one to two percent of all cases, “but when you do 150 cases per day like we do here at Wake, one percent is a lot," says Reynolds. “We're one of those fields that sees one percent as a big number (given the consequences of losing an airway) so we put a lot of energy into training for that rare but dangerous problem."

Aside from being fast, portable, battery operated and inexpensive, the lightwand carries a further benefit that increases efficiency and safety. There are numerous other specialized airway tools that are designed to provide better visualization of the target, which may or may not actually result in the breathing tube being put in the correct place. In contrast, the lightwand actually carries the breathing tube into the trachea and leaves it there, greatly limiting the ways in which it can fail.

Lightwand Training for Residents

The anesthesiology residency focuses heavily on airway instruction, each doctor manages more than a thousand airways during their residency. There is not an airway rotation per se, says Reynolds, “but training with alternative devices is incorporated into the curriculum every day, so graduates are ready for the hard ones. You're never going to have a zero failure rate, but you sure can lower the failure rate by using the right tool for the job. Our residents master the lightwand, make it part of their motor memory, so they can deploy it in the ICU in the middle of the night after standard tools have failed.

 
 

Lightwand Intubation Videos and Presentations

A series of videos and multimedia presentations describing a technique for lightwand intubation was developed at the Wake Forest University Department of Anesthesiology. The series includes a brief video demonstration of an anesthesia resident using this technique and presentations describing tips, indications and pitfalls of lightwand intubation.