Lighted stylet tracheal intubation: a review.

Tracheal intubation is older than the recognized history of general anesthesia itself. In the late 18th century, The Royal Humane Society of London used tracheal intubation for resuscitating the near-drowned. Approximately 100 years later, MacEwan (1) performed a digital tracheal intubation in an awake patient before a chloroform and air general endotracheal anesthetic for the resection of a tongue tumor, and in 1928, Magill (2) incorporated blind nasal tracheal intubation as a part of a general anesthetic. Although laryngoscopes were invented in the 19th century, tracheal intubation under direct visualization was greatly enhanced by the development of a special laryngoscope blade by Macintosh (3) in 1943. The first reported use of a lighted stylet used to facilitate intubation came in 1957 when (by now Sir Robert) Macintosh (4) described an 18-inch illuminated tracheal tube introducer, which was designed to stiffen the tube and better illuminate the cords by supplementing the light of the laryngoscope. Berman (5) described a similar device in 1959 and said it was useful “when the fickle light of the laryngoscope has gone out at the most inopportune time.” In the same year, Yamamura et al. (6) described a light bulb-tipped wire that was inserted into the tracheal tube before blind nasal intubation in awake patients. The tube position was then determined by the medial transillumination of the external throat and neck. In 1977, Foster (7) used a transilluminating fiberoptic bundle to facilitate tracheal intubation in a young child with trismus, and Ducrow (8), in the following year, used a flexible surgical light (Flexi-lumTM, Concept Corporation, Clearwater, FL) to achieve the same end by first passing a guide (two plastic suction catheters connected end-to-end) into the trachea followed by passage of the tracheal tube over the guide. In a correspondence to the latter article, Rayburn (9) commented that the Flexi-lumTM could be positioned inside the tracheal tube, thereby shortening the intubation sequence and claimed that the technique, nicknamed “lightwand intubation,” had been used for some years at the Brooke Army Medical Center.