Intubation With A Stylet With Light: Indications And Contraindications

One of the most striking aspects of intubation with a stylet with light is that it is easy to learn and the procedure lasts a maximum of about 23 seconds.

Intubation with a lighted stylet, also called an illuminated stylet, is a versatile and highly efficient technique. It is used for oral or nasal intubation in sleeping or awake patients. It has also been shown to be 99% effective in experienced hands.

The principles of lighted stylet intubation were described by Drs. MacIntosh and Richards in 1957. Since then, great advances have been made in stylets, making them a frequently used tool in anesthetic practice.

The primary goal of lighted stylet intubation is to perform intubation without resorting to direct laryngoscopy. The maneuvering time required is around 23 seconds and the complications it generates are minimal according to the available documentation.

What is the stylus with light

The lighted stylet, or luminous stylet, is a device that consists of three parts: a reusable handle, a rigid retractable stylet, and a flexible plastic tube. The tube is a malleable wand that has a very bright spot of light at one end.

Thanks to this luminous property of the tube, it is possible that intubation is carried out in normal conditions, or in low light, or blind. For its part, the stiletto takes the shape of a hockey stick, which facilitates its introduction.

The stylets are usually made of a malleable metal and are covered with plastic. They have a blunt tip. They must be placed inside the endotracheal tube, in such a way that the tip does not exceed the end of it. They give stiffness or shape to the endotracheal tube.

Light stylet intubation

The luminous stylet and appropriate tracheal tubes are basically required to perform lighted stylet intubation. The light quality of the stylet should first be checked and the tube pneumoblating verified.

The tube and the distal area of ​​the stylet should be lubricated immediately. Then insert the stylet into the orthotracheal tube and make a 90 ° angle. The patient should have the head in a neutral position and the rescuer should be at the head of the rescuer.

The technique consists of sedating if necessary, preoxygenating, and then performing the following actions :

• Pull the lower jaw.
• Insert the stylet-tube unit.
• Advance gently toward the laryngeal prominence of the thyroid cartilage.
• Remove the stylet.
• Fill the pneumoblog.
• Check the position of the tube.
• Fix it.

Indications for lighted stylet intubation

Lighted stylet intubation is performed in patients with a difficult airway. It can be combined with other airway management techniques. Helps in direct laryngoscopy, mask intubation and retrograde. Additionally, lighted stylet intubation is indicated in the following cases:

• When the patient presents malformations in the airway.

• In adults who have limitations in mouth opening, or contraindicated or decreased cervical mobility.
• In case of nasotracheal intubation.

Intubation with a lighted stylet is a suitable method for emergencies or out-of-hospital care. This, because learning the technique is very simple, as well as its application.

Contraindications to lighted stylet intubation

There are some relative contraindications to light stylet intubation. This means that they must be assessed based on the circumstances. These contraindications are morbid obesity and the presence of sunlight. The contraindications themselves for the use of this method are:

• Presence of tumors, polyps, or retropharyngeal abscess.
• Presence of a foreign body in the upper airway.
• Multiple trauma where there is a significant pharyngeal injury.
• That there are other friable tissues (that is, that are easily crushed or crumbled) in the intubation tract.

This intubation technique is most effective when one pillow is placed under the head and another under the shoulders to extend the neck. There is also greater efficiency when ambient light is poor.

Lighted stylet intubation rarely causes complications. Only in a few cases does airway trauma or dislocation of the arytenoid cartilages occur. Care should be taken that the stylet or any of its components are not disarticulated during the procedure.