Chapter 8

Direct laryngoscopy for orotracheal intubation requires direct visualization of the vocal cords and glottis. It is a time-honored method that is effective for securing most airways. Occasionally, difficulties may be encountered where the airway cannot be properly visualized. Airways may be difficult because of anatomic variations, disease processes, trauma, or particular clinical settings (Table 8-1). These airway challenges require alternative approaches. The lighted stylet is an innovative alternative that provides a safe, rapid, relatively easy, and indirect approach for airways that cannot be easily visualized by direct laryngoscopy.

Table 8-1. Indications for Intubating with a Lighted Stylet

The concept of using a light-guided introducer for orotracheal intubations first appeared in print in the late 1950s. Several authors described rather ingenious devices to tunnel a lightbulb attached to an introducer through the endotracheal tube and power it with a pocket battery, penlight, or laryngoscope handle.1–4 These primitive devices were simple and effective. Although intriguing, further development of this technology was stagnant until the late 1970s, when several authors described use of the Flexilum surgical light as a lighted stylet or “lightwand.”5,6 After a few problems with bulb dislodgment, the makers of the Flexilum light revised the design and marketed the first lighted stylet, known as the Tube-Stat (Concept, Inc.).7,8 A similar design is still available as the Tube-Stat lighted intubating stylet (Medtronic Xomed, Jacksonville, FL). In the mid-1990s, Laerdal introduced the more sophisticated Trachlight. It was an improvement over previous lighted stylets with a more intense light source, a more flexible lightwand, and a separate retractable stylet that adjusts to a variety of endotracheal tube lengths.9

There are two models of lighted stylets available today. The Tube-Stat (Medtronic Xomed, Jacksonville, FL) is the simplest. It incorporates a stylet, power source, and lightbulb all in a single piece. The unit is inserted into the endotracheal tube in place of the stylet. A switch on the handle activates the light. The second available model is the Trachlight (Laerdal Medical Corporation, Wappingers Falls, NY). It comprises a battery-powered handle, the lightwand, and a separate stylet that inserts into the lightwand (Figure 8-1). It is a simple device to operate (Figure 8-2). It is likely that further developments will continue to make these and similar models attractive options in airway management.

###### FIGURE 8-1

The Trachlight lighted stylet.

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