An Illuminating Stylet as an Aid for Tracheal Intubation Via the Intubating Laryngeal Mask Airway

To the Editor: The success rate for tracheal intubation via the intubating laryngeal mask airway (ILMA) is high [1]. However, resistance is encountered at the attempt in passing the endotracheal tube (ETT) through the ILMA in approximately 50% of patients and adjusting maneuvers of the ILMA based on the cause of resistance are needed [1,2]. The cause can be decided only by the depth of the ETT at which resistance occurs [2]. We used an illuminating stylet (Trachlight[trade mark sign]; Laedal Medical Corp., NY) [TL]) as an aid for successful intubation via the ILMA, as shown in Figure 1.Figure 1: Tracheal intubation via an intubating laryngeal mask airway (ILMA) using the illuminating stylet (Trachlight[trade mark sign]; [TL]). The stiff internal stylet is withdrawn from the wand of the TL. The TL threaded through the Murphy hole of the endotracheal tube (ETT) is inserted into the metal tube of the ILMA. The TL is advanced gently through the laryngeal inlet into the trachea using the light as a guide. The ETT is then passed over the TL into the trachea.Our method offers some advantages. First, transillumination of the soft tissue of the neck can assist in guiding the tip of the TL into the trachea and clarify the cause of resistance during passage of the ETT. Second, the thin, soft wand of the TL is more easily inserted through the laryngeal inlet into the trachea compared with the ETT. Third, traumatic airway complications may occur less frequently using our method versus conventional intubation via the ILMA because the stiff internal stylet of the TL is not used. To succeed using our method, the tip of the TL must protrude beyond the tip of the ETT, as previously stated. However, the wand is too short. Thus, we threaded the TL through the Murphy hole of the ETT [3]. An disadvantage is that the standard cuffed