A comparison of conventional and modified jaw thrust maneuvers for tracheal intubation using a lightwand

Abstract

Introduction: A lightwand is an effective device for tracheal intubation, and has been widely used in clinical practice. We evaluated the effects of conventional and modified jaw thrust maneuvers on lightwand search time, number of intubation attempts, intubation time, hemodynamic changes, and postoperative sore throat in patients undergoing orotracheal intubation using a lightwand.

Methods: Sixty adult patients were included in the study. After induction of anesthesia, intubation was performed using a lightwand under conventional (n=30) or modified jaw thrust (n=30) maneuvers. In the conventional group, the lightwand was inserted with the right hand after the mandible was lifted by placing the thumb of the left hand into the mouth. In the modified group, the lightwand was inserted while jaw thrust was achieved by an assistant using two hands. Lightwand search time (time from insertion of the lightwand to the moment of transillumination over the cricothyroid membrane), number of intubation attempts, and time to achieve intubation were assessed. Heart rate and mean arterial pressure were measured before and after intubation. Postoperative sore throat was evaluated at 1 and 24 h after surgery using a 0−100 mm visual analogue scale (VAS).

Results: Lightwand search time was significantly shorter in the modified group compared to the conventional group (7.2 [4.6] s vs. 12.1 [9.1] s, mean [SD], respectively

P=0.016). The modified group had shorter intubation time than the conventional group (21.0 [6.6] s vs. 27.9 [9.9] s, respectively

P=0.004). The number of intubation attempts, and hemodynamic changes after intubation were similar between the two groups. The incidence and severity of postoperative sore throat were lower at 24 h after surgery in the modified group compared with the conventional group (P=0.011).

Conclusion: The modified jaw thrust maneuver facilitated lightwand-guided intubation, and reduced the incidence and severity of postoperative sore throat compared to the conventional method.