medwireNews: Retrograde light-guided laryngoscopy (RLGL) is an effective alternative to conventional direct laryngoscopy (DL) for tracheal intubation and may also improve the success rates of novice laryngoscopists, suggest study findings.
Xiaoming Deng (Second Military Medical University, Shanghai, China) and colleagues found that RLGL enables novice laryngoscopists to intubate patients with greater success and speed than conventional DL.
Writing in Anesthesiology, the researchers explain that a beginner laryngoscopist usually needs to perform around 50 intubations to reach a 90% success with conventional DL. However, proposed alternatives, such as the lighted stylet, intubating laryngeal mask, and video laryngoscope are expensive and not widely available.
RLGL, in which the glottis is visualized using retrograde transtracheal light transmission from an external light source attached to the skin, could provide greater success for beginners in comparison with antegrade illumination in DL.
A total of 20 individuals who had never intubated a patient before but who had handled both intubation techniques on a manikin, were recruited for the study. The operators intubated 205 patients in total using either DL or RLGL (five intubations with each technique).
The success rate in the RLGL group was significantly greater than for the DL group (72 vs 47%).
RLGL was also associated with a shorter median time to glottis exposure (27 vs 45 seconds), shorter median intubation time (66 vs 120 seconds), and decreased throat soreness (2.1 vs 3.7 cm on the visual analogue scale) compared with the DL group.
The researchers conclude that RLGL is an effective alternative approach for intubation.
"It is a simple, inexpensive, and easy-to-learn technique that may supplement conventional laryngoscopy," they write.
In an accompanying editorial, John Fiadjoe and Paul Stricker, from The Children's Hospital of Philadelphia in Pennsylvania, USA, say that teachers of laryngoscopy could use this tool to enhance learning and improve the success rates of novice laryngoscopists.
"However, many questions remain and further research is required to discover the broader implications of this new approach," they conclude.
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