Laryngoscopes

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Laryngoscopes:


Laryngoscopes are devices consisting of flexible, lighted tube that allow to view the larynx or voice box either directly or indirectly.

Types of Laryngoscopes:


There are basically two types of Laryngoscopes including Direct an Indirect Laryngoscopes.

  • A direct line of sight can be established between the eye of the practitioner and the larynx in case id direct laryngoscopes. Typical handle and blade assemblies, such as McIntosh or Miller blades are included in direct laryngoscopes.Direct laryngoscopes are also used by head and neck surgeons during laryngeal or tracheal surgeries.
  • Camera with or without fiberoptic technology can be used in case of indirect laryngoscopes to view the larynx. Videolaryngoscopes or optical stylets can be included in such devices. An 'around the corner' look at the larynx is allowed by moving the point of view downwards along the curved laryngoscope blade closer to the vocal chords.

Some facts about Laryngoscopes:

 

  • Most of the laryngoscope blades are made from steel and are chrome plated.All blades are available in various sizes for every age of patients.
  • Placement of the ETT into the trachea under direct vision is possible by using a lLaryngoscope.
  • Damage to the teeth is the main injury caused by using laryngoscopes. A change of the patient's head position may lead to success in cases of inadequate visualization of the vocal cords.
  • A blade of inadequate size is responsible for intubation failure in some cases.
  • Optimal positioning of the patient is required for obtaining a view of the vocal cords with a conventional laryngoscope. Positioning is not an issue, and damage to the teeth is less likely with  a flexible fiberscope.
  • A video image of the oropharynx and the laryngeal inlet can be transmitted from the camera in the tip of the blade that allows laryngoscopy and intubation in positions other than the sniffing position with Glidescope video laryngoscope, Airtraq laryngoscope, McGrath video laryngoscope, Pentax Airway Scope (Pentax AWS), and Truview video laryngoscope. So, the number of difficult or failed intubations and the incidence of dental damage can be reduced.
  • Laryngoscopes can be modified to optimize visualization of the vocal cords. A  better view of the glottis can be achieved by drawing the epiglottis up with Corazelli-London and McCoy-Mirakuhr flexible-tip blades.
  • Direct visualization of the laryngeal inlet in children can be done with the Bullard laryngoscope    
  • The Bullard laryngoscope, and the intubation tracheoscope are not commonly used in anesthesiology as they require skilled handling. The position within the larynx is similar to a laryngoscope blade, and the direction of force used to displace the tongue is similar to a standard laryngoscope.
  • A visualization around a 90 degree bend at the tip around the base of the tongue can be provided in Bullard laryngoscope which may be helpful for direct visualization of the larynx in children with mandibular hypoplasia syndromes.
  • It is available in adult, pediatric, and pediatric long sizes and combines fiberoptic bundles and mirrors.
  • The adult size, with 2.5 cm wide blade is suitable for children older than 10 years. The pediatric version has 1.3 cm wide blade that extends 0.6 cm beyond the fiberoptics and is suitable to use for newborn to age 2 years. This blade is recommended to use for neonates, infants, and smaller children. The pediatric long version which has a longer blade with 1.4 cm and a wider flange with 1.6 cm is available for use in infants and small children up to age 10.
  • The Bullard laryngoscope has been used to intubate patients with unstable cervical spine or with Pierre Robin, Treacher Collins, Noonan's, or Klippel-Feil syndrome as it requires minimal mouth opening for its insertion.
  • The adult Bullard laryngoscope can be used to intubate infants older than 12 months with normal airways.
  • A similar view can be provided with the adult Bullard laryngoscope and a slightly longer time is require for intubation in children aged 1 to 5 years.

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