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Rapid tracheal intubation, using the standard Macintosh laryngoscope, can be hindered in obstetrical patients by the handle of the laryngoscope hitting the patient's engorged breasts and the hand of the assistant applying cricoid pressure. To overcome these difficulties a variation of the laryngoscope is described. The right angle of the blade to the handle is opened by a further 20 degrees.
OBJECTIVES: To assess whether the use of video laryngoscope, when compared to conventional laryngoscope decreases pain (assessed by Faceless Acute Neonatal Pain Scale) in preterm neonates while administering surfactant by LISA. METHODS: Preterm neonates < 35 weeks requiring FiO2 > 0.3 on CPAP pressure of at least 6 cm of H2O were administered surfactant by LISA technique either by video laryngoscope (Intervention) or conventional laryngoscope (Control). Faceless Acute Neonatal Pain Scale was used to determine pain 5 min before the procedure, immediately, 5 min, and 10 min after the procedure. The primary outcome was severity of pain; secondary outcomes were time taken to complete the procedure, number of attempts, incidence of IVH, and adverse events during the procedure. RESULTS: In total, 42 neonates of < 35 weeks gestation with comparable baseline demographics were randomized into 2 groups. The median (IQR) FANS score immediately post-procedure in the intervention arm was 2 (2-4) versus 2 (1-4) in the control arm, p = 0.79. There was no statistical difference in the secondary outcomes studied. CONCLUSION: The two groups had no difference in the pain score. The pain experienced by neonates during the LISA procedure was moderate and of short duration and it did not depend on the type of laryngoscope used. Moderate pain during the procedure can be managed with nonpharmacological measures; thereby, the use of sedatives or analgesics can be avoided, which might be of concern. There was no difference in the number of attempts or in time taken to complete the procedure when performed by neonatologists experienced in using conventional laryngoscopes compared to video laryngoscopes. TRIAL REGISTRATION: Clinical Trial Registry of India: CTRI/2022/09/045204 on 05.09.2022.
The Bullard laryngoscope is an anatomically shaped rigid fiber optic instrument designed for indirect laryngoscopy and intubation. It requires no neck extension nor flexion to perform laryngeal intubation. This characteristic is especially useful in the case of difficult airway. The Bullard laryngoscope, however, with which it is easy to visualize the cords, has not been popular yet, because using the intubating forceps mechanism requires a certain amount of skill. The intubation method developed by us with Bullard laryngoscope has been tried on 26 patients with difficult airway and ten patients with normal airway. An endotracheal tube is inserted through nostril, and intubation is performed viewing the tube and larynx during all the processes of intubation. Three kinds of endotracheal tubes, i.e. Magill type plain tubes, styletted tubes, and directional tip tubes, are compared. The method using a directional tip tube (Endotrol) is concluded as the best among them. The Endotrol tube itself has such a suitable shape for nasal intubation that it can be introduced to the larynx with little directional change. Therefore, our method is mastered with a shorter training period than the intubation method with fiber-optic laryngoscopes. In conclusion, our intubation method with the Bullard laryngoscopes using the directional tip tubes (Endotrol) is useful for patients with difficult airways, and is also nontraumatic and easy to perform.
A new laryngoscope was constructed in order to improve visualization of the larynx and to adjust the instrument to individual situation. The Kleinsasser laryngoscope was divided into two parts. The width between these two halfs can be changed by screws. Because the laryngoscope is open laterally there is more space for the operator and shorter instruments can be used.
Two cases of large epiglottic cysts are reported. Histopathological examination revealed a retention cyst in one case and an epidermoid cyst in the other. We designed a side-opened direct larngoscope and snare for treating epiglottic cysts. This direct laryngoscope is characterized by an opening from the anterior tip to the posterior end of the right side. The removal of the cysts was accomplished by using this direct laryngoscope and a snare under inhalation anesthesia by fiber optic guided endotracheal intubation. The side-opened direct laryngoscope enabled easy insertion of the snare through the right side opening.
STUDY OBJECTIVE: To determine (a) whether the ability to visualize a patient's airway preoperatively correlates with the ability to visualize his or her larynx during laryngoscopy and (b) whether the presence of certain anatomic characteristics allows anesthetists to predict difficult laryngoscopic visualization and intubation. DESIGN: Observational. Patients were categorized into two groups: those who had one or more physical characteristics to alert an anesthetist to the possibility of difficult intubation (obesity, overbite, short neck, or decreased neck/jaw mobility) and those with none of these characteristics. SETTING: University-affiliated hospital. PATIENTS: Six hundred sixty-five patients scheduled for general anesthesia and requiring endotracheal intubation. Patients were between the ages of 18 and 88 years, with body weight ranging from 21 kg to 141 kg. INTERVENTIONS: Preoperatively, the anesthetist obtained the best view of the hypopharynx by having the patient extend the tongue and phonate. The airway was then categorized into one of three classes by the ability to see the tonsillar pillars and uvula (Class A, best view--all four tonsillar pillars and uvula seen; Class B, part of the pillars and uvula seen; Class C, worst view--pillars not seen and uvula partially or not seen). After induction, the same anesthetist graded laryngeal visibility into one of four groups depending on his ability to see the patient's epiglottis and vocal cords. MEASUREMENTS AND MAIN RESULTS: Patients with one or more clinical clues were more likely to have poor visualization of the hypopharynx and, in turn, poor laryngoscopic visualization of the glottis. Patients who had a Class A airway tended to have easy laryngoscopic visualization and were relatively easy to intubate. Conversely, patients with no clinical clues and a Class C airway had poor glottic exposure. CONCLUSIONS: Our study confirms work showing that the ability to visualize structures of the hypopharynx is a good predictor of subsequent glottic visualization during laryngoscopy and of ease of intubation.
Eleven patients, with a cervical spine injury and scheduled for elective cervical spine fusion at least 48 h after their initial trauma, were intubated using a new fiberoptic laryngoscope (Bullard). This technique uses either a semi-rigid guide independent of the laryngoscope blade, or a rigid one attached to the blade. The cervical spine was immobilized with either a collar or a halo. General anaesthesia was carried out with thiopentone, fentanyl and vecuronium bromide. Orotracheal intubation was successful at the first attempts in 10 out of the 11 patients. No mobilization of the cervical spine occurred. In the first six patients, the semi-rigid guide was used, and the rigid one in the remaining five. The anaesthetist who carried out the intubations was always the same. Using the rigid guide was easier than the semi-rigid one. This is confirmed by the time required, 44 +/- 22 sec for the rigid guide, and 97 +/- 92 sec for the semi-rigid one. In the patient in whom this technique failed at the first attempt, endotracheal intubation was carried out by the nasal route and controlled by the fiberoptic laryngoscope. This technique enables a rapid and easy orotracheal intubation in trauma patients with an immobilized cervical spine, but careful training is necessary.
BACKGROUND: Pediatric airway management traditionally emphasizes strict adherence to age-based laryngoscope blade size recommendations, despite limited empirical validation. OBJECTIVES: To evaluate whether intubation performance varies across a range of blade sizes, and whether a Macintosh 2 blade performs comparably across multiple pediatric age groups in a simulation setting. METHODS: We conducted a randomized crossover simulation study using three pediatric airway manikins (neonate, infant, and child age groups). Emergency medicine residents and faculty physicians performed intubations using multiple laryngoscope blade types and sizes, including standard and nonstandard options. Primary outcomes were intubation time and first-attempt success. Secondary outcomes included complications and operator-rated ease of glottic view and tube passage. Between-blade differences were estimated with 95% confidence intervals. RESULTS: Across manikin sizes and blade types, intubation times were short and first-attempt success rates exceeded 98% in most conditions. Performance remained consistent even with blade sizes outside conventional age-based recommendations. Between-blade differences in intubation time were small, and complication rates were low across conditions. The Macintosh 2 blade performed comparably across all manikin sizes, with similar intubation times, high success rates, and favorable ease ratings. CONCLUSIONS: Intubation performance in pediatric manikin models was similar across a wide range of blade sizes. These hypothesis-generating findings warrant prospective clinical evaluation of simplified blade selection strategies for pediatric intubation.
A laryngoscope blade with an integrated suction tube is described. Suction and laryngoscope can be handled simultaneously by one hand. The suction guarantees a free sight during intubation in cases of bleeding in the nasopharyngeal region and may also prevent the aspiration of acid gastric contents.
A laryngoscope blade incorporating a suction tube is described. Blood or secretions are automatically aspirated from the pharynx when the blade is inserted.
A 22-month-old child had a generalized tonic-clonic seizure during attempted orotracheal intubation and broke the laryngoscope bulb with his teeth. The glass was swallowed but passed uneventfully through the gastrointestinal tract. The possibility of this unusual complication should be considered when patients at risk for seizures are intubated by the orotracheal route.
The trachea of a man who had cut his own throat was successfully intubated using a fibreoptic laryngoscope after attempts at conventional oral intubation had failed. The advantages of the fibreoptic instrument and the method of use in such an injury are discussed.
A new laryngoscope incorporation a mechanism operated from the handle which facilitates endotracheal intubation in situations where an introducing stylet would normally be required.
A new developed laryngoscope (epipharyngoscope) is demonstrated, which comes now to production stage after three years of experimental work. The endoscope-a high capacity optical system with an angled direction of view-allows a thorough inspection and easy fotodocumentation of the larynx and epipharynx without molesting the patient. Even under difficult conditions regarding the anatomy the findings can be inspected as a survey or under magnification, which is done-technically an innovation-by moving an integrated lens system of the endoscope.
Management of the patient with a full stomach ideally requires an anaesthetist with many hands--to cope with laryngoscopy, suction and intubation. The design of a standard McIntosh laryngoscope blade was modified to include a suction port. This design change released one of the anaesthetist's hands for intubation. The prototype was found to provide inadequate suction and was further modified. The final model proved to be very effective for intubation in situations where visualisation of the larynx was obscured by secretions.
The technique of percutaneous injection of Teflon paste into a paralysed abducted vocal cord using a fibre optic laryngoscope to observe and control the effect is described. Its use in vocal cord paralysis caused by inoperable bronchogenic carcinoma and the results in 14 patients are discussed.
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