The lightwand places a light source at the tip of the endotracheal tube (ETT). After the lightwand is threaded through the tube, the two are advanced blindly into the pharynx, aiming for the glottis. A “halo” of light visible over the front of the neck provides guidance for insertion of the tube and lightwand into the glottis, using gentle probing or rocking maneuvers. Transillumination of the larynx confirms that the tube is indeed being advanced into the airway.

In the late 1950s, Yamamura¹ described transillumination for use in nasotracheal intubation. The use of the lighted stylet, or lightwand, has been well described since then, as a blind technique in the setting of difficult laryngoscopy, as well as for routine airway management.²,³,⁴ Early commercial lightwands suffered from poor illumination and misdirection of the light, so that a darkened room was necessary to see the halo produced in the glottic area during insertion into the airway. The lamp switch was often placed in an awkward position. Further, an overly rigid stylet could cause retraction of the ETT out of the glottis when the lightwand was withdrawn.² Newer models have improved upon the visibility of the light, as well as the ergonomics of the device.⁵ The Trachlight (Laerdal, Long Beach, CA), with its three-piece retractable wire lighted stylet, facilitates advancement of the lightwand-ETT and makes it unlikely that the ETT will be withdrawn from the trachea when the Trachlight device is pulled back. A locking device for the proximal portion of the ETT, and an adjustable length to accommodate different size tubes, also represent significant improvements of the Trachlight over earlier lighted stylets.⁵

In the operating room (OR), lighted stylet intubation has proven reliable and highly successful in both adults and children, in routine airway management and difficult airways.⁶ Yamamoto⁷ suggested in his study of inexperienced intubators that approximately 30 intubations are required to become adept with the use of lighted stylet technique. Ainsworth⁴ described intubation using the lighted stylet within 60 seconds in 200 patients under general anesthesia, whereas Weis⁸ reported a series of 250 patients in whom he had 99% success in intubation using this device. In 950 surgical patients, use of the Trachlight was compared with direct laryngoscopy for efficacy in tracheal intubation.⁵ Direct laryngoscopy was found to require more time, produce more complications, and result in a higher failure rate (3% vs. 1%). In addition, Tsutsui⁹ found in a series of 305 patients that lighted stylet intubation with the Trachlight resulted in less of a blood pressure response as compared with direct laryngoscopy. In 186 documented difficult airway patients, Hung¹⁰ used the Trachlight lighted stylet for intubation after induction of anesthesia with 99% success. In 2009, 60 patients with high Mallampati score were studied by Rhee et al in a prospective randomized comparison of lighted stylet and direct laryngoscopy intubation techniques. The authors demonstrated shorter intubation times and a higher first attempt success rate as well as smaller alterations in blood pressure in the lighted stylet group as compared with the direct laryngoscopy group.¹¹

In the emergency department (ED), lighted stylets have also proven useful for airway management in facial trauma and appear to facilitate intubation while preserving immobility of the cervical spine.¹²,¹³ In a series of 28 trauma patients with suspected cervical spine injury, the lightwand was employed for intubation with 100% success.¹⁴ The device has been adapted for nasotracheal intubation as well as orotracheal use.¹²,¹⁵ In prehospital care, Vollmer³ reported the use of the lighted stylet by emergency medicine residents in 24 patients with 88% success in less than 45 seconds.

The lightwand has been recommended for use in patients with known or potential cervical spine injury, as its use requires little or no motion of the cervical spine. Turkstra et al¹⁶