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Canadian Journal of Anaesthesia

, Volume 36, Issue 1, pp 94–98 | Cite as

Laryngoscope design and the difficult adult tracheal intubation

  • J. W. R. McIntyre
Special Article

Abstract

Clinical examination of a patient is very likely to reveal the factors making tracheal intubation difficult and thus increasing the likelihood of a traumatized temporo-mandibular joint or mouth. Although laryngoscopes and bronchoscopes incorporating fiberoptic visual devices are invaluable they are usually only employed for extremely difficult patients. Other laryngoscopes exist in a variety of designs and can be categorised according to the particular problem they address: (i) prominent sternal region, (ii) narrow space between the incisors, (iii) reduced intraoral space and, (iv) the anteriorly positioned larynx. An atraumatic tracheal intubation will be assisted if the laryngoscope blade to be used is selected on the basis of the anatomic difficulties prescribed by the patient. The Miller, Jackson-Wisconsin, Macintosh, Soper, Bizarri-Guffrida, and Bainton blades together with appropriate handles and fittings comprise a group from which selection can be made.

Keywords

Tracheal Intubation Vocal Cord Tracheal Tube Difficult Tracheal Intubation Laryngoscope Blade 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Lors de ľexamen physique ďun patient, on peut habituellement prédire si ľintubation trachéale risque ďêtre difficile et susceptible ďendommager bouche et articulation temporomandibulaire. Pourtant, on a tendance à réserver ľusage des laryngoscopes et bronchoscopes à fibres optiques flexibles aux cas les plus complexes. On peut classifier les autres types de laryngoscope en fonction des particularités anatomiques qu’ils permettent de contourner: sternum proéminent, espace resteint entre les incisives, petit volume de la cavité orale, larynx dit antérieur. En choisissant parmi les Miller, Jackson-Wisconsin, Macintosh, Soper, Bizarri-Guffrida et Bainton, les lames et manches de larygoscope appropriés à la morphologie du patient, on pourra plus facilement intuber la trachée en douceur.

References

  1. 1.
    MacEwan W. Clinical observations on the introduction of tracheal tubes by the mouth instead of performing tracheotomy or laryngoscopy. Br Med J 1880; 2: 122–4, 163-5.Google Scholar
  2. 2.
    Miller RA. A new laryngoscope. Anesthesiology 1941; 2: 318–20.Google Scholar
  3. 3.
    Macintosh RR. A new laryngoscope. Lancet 1943; 1: 205.CrossRefGoogle Scholar
  4. 4.
    McIntyre JWR. The difficult tracheal intubation. Can Anaesth Soc J 1987; 34: 204–13.CrossRefGoogle Scholar
  5. 5.
    Cooper JB, Newbower RS, Kitz RJ. An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. Anesthesiology 1984; 60: 34-42–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Dorsch JA, Dorsch SE. Understanding anesthesia equipment. Williams and Wilkins, Baltimore. 2nd ed. 1984.Google Scholar
  7. 7.
    Jellicoe JA, Harris NR. A modification of a standard laryngoscope for difficult tracheal intubation in obstetric cases. Anaesthesia 1984; 39: 800–2.PubMedCrossRefGoogle Scholar
  8. 8.
    MacBeth RG, Bannister FB. A new laryngoscope. Lancet 1944; 247: 660.CrossRefGoogle Scholar
  9. 9.
    Bowen RA, Jackson I. A new laryngoscope. Anaesthesia 1952; 7: 254–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Beaver RA. Special laryngoscopes. Anaesthesia 1955; 10: 83–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Kessell J. A laryngoscope for obstetrical use, an obstetrical laryngoscope. Anaesth Intensive Care 1977; 5: 265–6.PubMedGoogle Scholar
  12. 12.
    Lagade MRG, Poppers PJ. Revival of the polio laryngoscope blade. Anethesiology 1982; 57: 545.CrossRefGoogle Scholar
  13. 13.
    Yentis SM. A laryngoscope adaptor for difficult intubation. Anesthesia 1987; 42: 764–6.CrossRefGoogle Scholar
  14. 14.
    Datta S, Briwa J. Modified laryngoscope for endotracheal intubation of obese patients. Anesth Analg 1981; 60: 120–1.PubMedCrossRefGoogle Scholar
  15. 15.
    Wiggin SC. A new modification of the conventional laryngoscope and technic for laryngoscopy. Anesthesiology 1944; 5: 61–8.CrossRefGoogle Scholar
  16. 16.
    Portier M, Wasmuth CE. Endotracheal anesthesia using a modified Wis-Foregger laryngoscope blade. Cleve Clin Q 1959; 26: 140–3.Google Scholar
  17. 17.
    Gubya R, Orkin LR. Design and utility of a new curved laryngoscope blade. Anesth Analg 1959; 38: 364.CrossRefGoogle Scholar
  18. 18.
    Schapira M. A modified straight laryngoscope blade designed to facilitate endotracheal intubation. Anesth Analg 1973; 52: 553–4.PubMedGoogle Scholar
  19. 19.
    Phillips OC, Duerksen RL. Endotracheal intubation: a new blade for direct laryngoscopy. Anesth Analg 1973; 52: 691–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Soper RJ. A new laryngoscope for anaesthetists. Br Med J 1947; 1: 265.Google Scholar
  21. 21.
    Gould RB. Modified laryngoscope blade. Anaesthesia 1954; 9: 125.PubMedCrossRefGoogle Scholar
  22. 22.
    Bizarri DV, Guffrida JG. Improved laryngoscope blade designed for ease of manipulation and reduction of trauma. Anesth Analg 1958; 37: 231–2.CrossRefGoogle Scholar
  23. 23.
    Onkst HR. Modified laryngoscope blade. Anesthesiology 1961; 22: 846–8.PubMedGoogle Scholar
  24. 24.
    Gillespie N. Endotrachaeal anaesthesia. University of Wisconsin Press, 1st ed. 1941.Google Scholar
  25. 25.
    Snow JC. Modification of laryngoscope blade. Anesthesiology 1962; 23: 394.CrossRefGoogle Scholar
  26. 26.
    DeCiutiis VL. Modification of Macintosh laryngoscope. Anesthesiology 1959; 20: 115–6.Google Scholar
  27. 27.
    Cartwright FF. Devices for anaesthesia in throat surgery. Anaesthesia 1953; 8: 119–20.PubMedCrossRefGoogle Scholar
  28. 28.
    Pope ES. Left-handed laryngoscope. Anaesthesia 1960; 15: 326–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Lagade MRG, Poppers PJ. Use of the left-entry laryngoscope blade in patients with right-sided oro-facial lesions. Anesthesiology 1983; 58: 300.PubMedCrossRefGoogle Scholar
  30. 30.
    Homan B, Hild J, Georgi W. Das modifizierte kleinsasserrohr: ideal fur dieschwierige intubation. Anaesthetist 1985; 34: 98–100.Google Scholar
  31. 31.
    Bainton CR. A new laryngoscope blade to overcome pharyngeal obstruction. Anesthesiology 1987; 67: 767–70.PubMedCrossRefGoogle Scholar
  32. 32.
    Cassels WA. Advantages of a curved laryngoscope. Anesthesiology 1942; 3: 580–1.CrossRefGoogle Scholar
  33. 33.
    Macintosh RR. An improved laryngoscope. Br Med J 1941; 27: 914.Google Scholar
  34. 34.
    Macintosh RR. Laryngoscope blades. Lancet 1944; 246: 485.CrossRefGoogle Scholar
  35. 35.
    Fink BR. Roentgen ray studies of airway problems. I. The oropharyngeal airway. Anesthesiology 1957; 18: 162–3.CrossRefGoogle Scholar
  36. 36.
    Gabuya R, Orkin LR. Design and utility of a new laryngoscope blade. Anesth Analg 1959; 38: 364–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Siker ES. A mirror laryngoscope. Anesthesiology 1956; 17; 38–42.PubMedCrossRefGoogle Scholar
  38. 38.
    Huffman J, Elam JO. Prisms and fiber optics for laryngoscopy. Anesth Analg 1971; 50: 64–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Patil VU, Stehling LC, Zander HC. Fiberoptic endoscopy in anaesthesia. Year Book Medical Publishers Inc. Chicago; 1983.Google Scholar
  40. 40.
    Donlon JV. Anesthesia for Eye, Ear, Nose, and Throat. In: Miller, RD (Ed). Anesthesia. 2nd ed. Vol 3. Churchill Livingstone, New York 1986; 1885–6.Google Scholar
  41. 41.
    Sykes WS. Essay on the first hundred years of anesthesia. Vol 2. E & S Livingstone, Edinburgh 1961; Ch 7.Google Scholar

Copyright information

© Canadian Anesthesiologists 1989

Authors and Affiliations

  • J. W. R. McIntyre
    • 1
  1. 1.Department of AnaesthesiaUniversity of AlbertaEdmonton

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