To the Editor:—
Many reports document the potential complications of lightwands in clinical practice. 1–6A complication we have encountered is the creation of a foreign body after intubating with the Vital Signs lightwand (Vital Signs, Inc., Totowa, NJ).
A 32-yr-old, 81-kg woman with diabetes mellitus, asthma, and hypertension was scheduled to undergo elective laparoscopy for lysis of intraperitoneal adhesions. After preoxygenation in the operating room, a routine induction was administered (fentanyl 50 μg, lidocaine 40 mg, propofol 200 mg, mivacurium 20 mg). The patient was ventilated without difficulty with bag-mask ventilation. After appropriate muscle relaxation was verified with a peripheral nerve stimulator, airway manipulation and intubation was completed. The technique for intubation was a Vital Signs lightwand. The nonlubricated lightwand was threaded through a 6.5-mm endotracheal tube with the tip of the lightwand proximal to the Murphy eye of the endotracheal tube. The lightwand was bent at a 75-degree angle about 3 cm proximal to the tip. After adequate transillumination of the glottis, the endotracheal tube was advanced into the trachea without difficulty. On withdrawal of the lightwand, however, increased resistance was experienced. The lightwand was removed with visible damage to its distal tip (fig. 1). Visual inspection confirmed the presence of a white foreign body from the damaged lightwand in the upper part of the endotracheal tube. The foreign body was removed easily from the endotracheal tube without extubating the patient. The remainder of the anesthetic administration proceeded uneventfully.
The complication may have been due to a structural flaw in the lightwand device, by not lubricating the lightwand before insertion into the endotracheal tube, or by a combination of both. Previous to the current case, we had performed over 200 lightwand intubations using 6.5-mm endotracheal tubes and nonlubricated Vital Signs lightwands with no complications. Subsequent to this case, however, we encountered two identical de-sheathings. We have queried Vital Signs to determine if any recent manufacturing changes had occurred in the construction of the lightwand (e.g. , change in plastic quality or assembly). A written reply received in June 2002 from Gail D. Rice, Compliance Engineer at Vital Signs stated that no changes had occurred and that this complication would not occur with a lubricated stylet. A randomized study might be useful in assessing the potential risks and benefits of lubricating versus not lubricating stylets. It also might be prudent for Vital Signs to consider a change in the design of their lightwand. If possible, elimination of the elevated ridges would lead to a decreased likelihood of friction, snagging, and plastic degloving.
