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When lighted stylet intubation is done correctly, the procedure can be very safe, with very little difference in outcome from that of primary laryngoscopy. (Note: several lighted stylet devices, such as the Trachlight TM and Light Wand TM , are no longer being manufactured, but these devices are still in use.)

The discovery of optogenetics has revolutionized research in neuroscience by providing the tools for noninvasive, cell-type selective modulation of membrane potential and cellular function in vitro and in vivo. Rhodopsin-based optogenetics has later been introduced in experimental cardiology studies and used as a tool to photoactivate cardiac contractions or to identify the sites, timing, and location most effective for defibrillating impulses to interrupt cardiac arrhythmias. The exploitation of cell-selectivity of optogenetics, and the generation of model organisms with myocardial cell type targeted expression of opsins has started to yield novel and sometimes unexpected notions on myocardial biology. This review summarizes the main results, the different uses, and the prospective developments of cardiac optogenetics.

BACKGROUND: Complete and homogeneous illumination of the pleural cavity is essential to the success of photodynamic therapy (PDT) for mesothelioma, but remains a challenge. Knowing the repartition and propagation of light around the light applicator could be the first step towards optimizing dosimetry. Here we propose a characterization method of the illumination profile of a specific light device. METHODS: The light wand, made of a cylindrical diffuser located inside an endotracheal tube, was fixed in a tank filled with dilute 0.01% intralipid. Light dosimetry was performed around the tip of the wand using two complementary methods: direct measurements of light power with an isotropic probe and measurements of light distribution characterization. RESULTS: Dosimetry with the isotropic probe showed an ellipse-shaped illumination. An optimized effective attenuation coefficient was deduced. Combined with the spatial representation, a theoretical illumination profile was established with iso-surfaces of fluence rate, defining a gradient light dose according to the distance from the diffuser. CONCLUSION: A theoretical illumination profile of a light device was established and could be part of an intra-operative dosimetry system to improve light delivery during intrapleural PDT. Copyright © 2016. Published by Elsevier B.V.

Objective To determine the correlation between anatomical features of the upper airway (evaluated via computed tomography imaging) and the ease of light wand-assisted endotracheal intubation in patients undergoing ear, nose and throat surgery under general anaesthesia. Methods Mallampati class, laryngoscopic grade, thyromental distance, neck circumference, body mass index, mouth opening and upper lip bite class were assessed. Epiglottis length and angle, tongue size and narrowest pharyngeal distance were determined using computed tomography imaging. Intubation success rate, time to successful intubation (intubating time) and postoperative throat symptoms were documented. Results Of 152 patients, 148 (97.4%) were successfully intubated on the first attempt (mean intubating time 11.5 ± 6.7 s). Intubating time was positively correlated with laryngoscopic grade and body mass index in both male and female patients, and Mallampati class and neck circumference in male patients. Epiglottis length was positively correlated with intubating time. Conclusions Ease of intubation was influenced by epiglottis length. Radiological evaluation may be useful for preoperative assessment of patients undergoing endotracheal intubation with light wand.

Purpose Tracheostomy speaking valve use may increase airflow resistance and work of breathing. It remains unclear which valve offers the best performance characteristics. We compared the performance characteristics of the Shikani speaking valve (SSV; unidirectional-flow ball valve) with those of the Passy-Muir valve (PMV; bias-closed flapper valve). Method Airflow resistance was measured for both the SSV and the PMV at 8 flow amplitudes and in 3 orientations (−15°, 0°, +20°) in the bias-open and bias-closed configurations. Results Significantly lower airflow resistance was observed for the SSV (bias open) compared with the PMV at −15° ( p < .001), 0° ( p < .001), and +20° ( p = .006) from the horizon. No significant difference was observed between the PMV and the SSV (bias-closed) configuration at any of the tested angles. A nonsignificant trend toward decreased airflow resistance was observed between the SSV bias-open and bias-closed configurations at each of the angles tested. Conclusions The SSV demonstrated lower airflow resistance compared with the PMV across 8 flow amplitudes in the bias-open configuration at −15°, 0°, and +20° from the horizon. Further investigation is needed to determine the clinical impact of these findings on patient comfort, work of breathing, phonation, and airway protection during swallowing.

When anesthesiologists encounter conditions in which intubation is not possible using a conventional direct laryngoscope, they can consider using other available techniques and devices such as fiber optic bronchoscope (FOB)-guided intubation, a laryngeal mask airway (LMA), intubating LMA (ILMA), a light wand, and the Combitube. FOB-guided intubation is frequently utilized in predicted difficult airway cases and is generally performed when the patient is awake to enable easier access to the trachea. An LMA can be introduced to ventilate the patient with relative ease, while an ILMA can be used for definite endotracheal intubation. However, occasionally, an endotracheal tube (ETT) cannot pass through the larynx, despite successful introduction of a FOB into the trachea and placement of an ILMA by the anesthesiologist. Therefore, we initially introduced an ILMA for emergent ventilation, followed by successful insertion of an ETT under FOB guidance. In this report, we describe three cases of difficult intubation using a FOB and ILMA combination approach.

Background Although percutaneous dilatational tracheostomy (PDT) under bronchoscopic guidance is feasible in the intensive care unit (ICU), it requires extensive equipment and specialists. The present study evaluated the feasibility of performing PDT with a light source in the surgical ICU. Methods The study involved a retrospective review of the outcomes of patients who underwent PDT with a light source performed by a surgery resident under the supervision of a surgical intensivist in the surgical ICU from October 2015 through September 2016. During the procedure, a light wand was inserted into the endotracheal tube after skin incision. Then, the light wand and the endotracheal tube were pulled out slightly, the passage of light through the airway was confirmed, and the relevant point was punctured. Results Fifty patients underwent PDT with a light source. The average procedural duration was 14.0 ± 7.0 minutes. There were no procedure-associated deaths. Intraoperative complications included minor bleeding in three patients (6%) and paratracheal placement of the tracheostomy tube in one patient (2%); these were immediately resolved by the surgical intensivist. Two patients required conversion to surgical tracheostomy because of the difficulty in light wand insertion into the endotracheal tube and a very narrow trachea, respectively. Conclusions PDT with a light source can be performed without bronchoscopy and does not require expensive equipment and specialist intervention in the surgical ICU. It can be safely performed by a surgical intensivist with experience in surgical tracheostomy.

Airway management in the operating room is the responsibility of anesthesiologists, although a variety of personnel may be responsible for airway management outside the operating room. Emergency department physicians are prominently involved in airway management in the emergency room both independently and with anesthesiologists. Airway management in trauma patients remains the domain of anesthesiologists. An 18-year old male patient was brought to our emergency room after an alleged history of suicidal attempt with gunshot under the chin. He was scheduled to undergo emergency tracheotomy, debridement, and closure of facial laceration under general anaesthesia, presenting a challenge for. He had to undergo emergency tracheotomy, debridement, and closure of facial lacerations under general anesthesia. The injuries made the patient′s airway management a complex issue. We present the use of the light wand to manage the difficult airway of this patient with complex facial trauma.

Summary This chapter reviews the problem of the management of the difficult airway. Although the incidence of difficulty is relatively small, the consequences of mismanagement can be quite disastrous. Prediction of the difficult intubation can be made by a variety of simple clinical observations and measurements in a majority of cases. A combination of these methods is likely to lead to a lower index of false positives. Radiological assessment may be valuable if planned beforehand. Nevertheless, a number of cases of unsuspected difficulty occur. The options available in cases of difficulty are reviewed, including direct laryngoscopy using the oral and nasal routes, fibreoptic guided intubation and the use of special guiding laryngoscope blades and ancillary devices such as the laryngeal mask, the pharyngotracheal lumen airway, the Combi tube and the light wand. The technique of retrograde guided intubation is described. The surgical airway is required in certain cases of impossible intubation. Cricothyrotomy is the technique of choice in the emergency situation because it is simpler and safer to perform. Tracheostomy may be preferred in the planned case with an anticipated long-term problem. Confirmation of correct tracheal tube placement is essential. Unrecognized misplacement leads to death or severe brain damage. Simple clinical methods are generally satisfactory but are not infallible. Other methods of confirmation such as fibreoptic visualization, light wand transillumination, carbon dioxide detectors and air aspiration are discussed. A regimen for difficult airway management is produced as an algorithm.

A lighted stylet is a useful device for routine or difficult endotracheal intubation. 1-3 With light-guided intubation, the incidence of complications is reported to he low, but the larynx can be injured during the blind advancement of the endotracheal tube. 1 We report a case in which malpositioning of the epiglottis occurred after tracheal intubation with a lighted stylet, and difficulty was encountered in replacing the displaced epiglottis. This case prompted us to observe closely a series of intubations by use of a light wand.

Background Transillumination using a light wand is an alternative type of laryngoscope used for tracheal intubation. There is little information available on the effect-site concentration of remifentanil required to control hemodynamic changes induced by tracheal intubation using the transillumination method during total IV anesthesia. We therefore conducted this study to determine the effect-site concentration of remifentanil blunting hemodynamic responses after tracheal intubation in patients receiving propofol anesthesia. Methods We enrolled 26 healthy adult patients (ASA physical status I-II), aged 16-67 scheduled for surgery within 2 hours. All patients received a target-controlled infusion of 4 µg/ml propofol. The effect-site target-concentration of remifentanil of 5.0 ng/ml was chosen for the first patient. We used the Dixon's up-and-down sequential allocation method for determining the next remifentanil concentration. The time required for tracheal intubation was measured as the level of intubation stimulation. Results The average intubation time was 13.9 ± 9.1 seconds. From the Dixon's method, the EC(50) of remifentanil blunting the hemodynamic response to tracheal intubation was 2.94 ng/ml. Conclusions This study shows that effect-site concentrations of remifentanil of 2.94 ng/ml is effective in blunting sympathetic responses to tracheal intubation in 50% of patients with normal airway anatomy when combined with a target controlled infusion of propofol (4 µg/ml).

Background and objectives: Approximately 1–3% of surgical patients have difficult airways, which accounts for the most important cause of anaesthesia-related morbidity and mortality. The fibreoptic bronchoscope is considered the gold standard for the management of difficult airways. However, blind nasal intubation remains a basic technique in developing countries, especially in remote areas where a Fiberoptic bronchoscope is not always available. The light wand is a simple, cost effective device, and has become a tool widely accepted in airway management under various clinical scenarios, including difficult airways. The study was conducted to evaluate the efficacy of light wand-guided nasotracheal intubation over blind nasal intubation. Methods: A total of 60 ASA Grade I & II patients of age 18-60 yrs of Body mass index between 18-25 kg/m2 with limited mouth opening (distance between upper and lower central incisors < 3.0 cm) posted for elective surgeries were divided into two equal groups in a randomized, double-blind fashion. Blind nasal group 30 patients Light wand Group: 30 patients Results: The first attempt and overall success rate of light wand guided nasotracheal intubation was 80% and 90% respectively, significantly higher than blind nasal intubation i.e. 50% and 66.66% respectively (p

Fibreoptic bronchoscopic guided tracheal intubation is often the first choice for clinicians familiar with the technique, when faced with a patient in whom tracheal intubation presents known or possible difficulties. Regardless of the technique chosen, anticipated and unanticipated problems may arise. We report three patients with known difficult airways that illustrate the utility of light wand guided oral and nasotracheal intubation when tracheal intubation with fibreoptic bronchoscopy proved impossible.

Background: Dental chair lights can rapidly polymerize light-reactive composites beyond the point of workability, preventing adequate time for the shaping and sculpting of large direct composite restorations. Purpose: The purpose of this study was to determine whether yellow plastic food wrap placed over a dental chair light would perceptibly retard the polymerization rate of a light-cured composite (Esthet-X™, shade A1, Dentsply/Caulk, Milford, DE, USA). Materials and Methods: Zero, one, and two thicknesses of yellow plastic food wrap (Reynolds Metals Company, Richmond, VA, USA) were, in turn, used in the following scenarios: (1) placed in a spectrophotometer and compared for percentage transmission of 470 nm light; (2) placed over a curing unit light wand and compared for milliwatts of output on a radiometer; (3) placed over a dental chair light positioned 64 cm from 0.22 mm thick composite specimens, with Fourier Transform Infrared Spectrometry readings made every 40 seconds to measure degree of composite polymerization; (4) placed over a dental chair light positioned 64 cm from a direct veneer preparation (clinical simulation), which was then restored by four experienced clinicians who reported working times. Results: Results for the scenarios were as follows: (1) zero sheets 100%, one sheet 34%, two sheets 6%; (2) zero sheets 580 mW, one sheet 190 mW, two sheets 20 mW; (3) percent conversion at 80 seconds–zero sheets 8%, one sheet 0.65%, two sheets 0.76%; percent conversion at 120 seconds–zero sheets 19.11%, one sheet 12.22%, two sheets 0.42%; (4) mean working times–zero sheets 34 seconds, one sheet 72 seconds, two sheets 155 seconds. Conclusions: Yellow plastic food wrap placed over a dental chair light markedly extended the working time of a light-cured composite in each of four assessments performed. Two sheets of plastic wrap were more than twice as effective as one sheet. CLINICAL SIGNIFICANCE The suggested filtering technique with yellow plastic wrap placed over a dental chair light is a highly effective, expedient, and inexpensive method for increasing the working time of light-cured composites.

We evaluated the use of an inexpensive trans-illuminating light wand for tracheal intubation. Expertise in its use was acquired quickly, thereby providing successful per-oral intubation in all patients who were able to open the mouth, irrespective of the view obtained of the epiglottis and larynx.

Use of the light wand for 253 intubations in a variety of clinical settings is described. Twenty patients were successfully intubated by the light wand method who had failed to be intubated by direct laryngoscopy. Three failures were noted on patients who weighed more than 350 pounds each. Both nasal and oral endotracheal intubations were accomplished with minimal morbidity.