Tracheal intubation using a Bullard laryngoscope for patients with a simulated difficult airway

  • Kirk MacQuarrie
  • Orlando R. Hung
  • J. Adam Law
Reports of Investigation



To evaluate the utility and safety of orotracheal intubation in adult patients with simulated difficult airways using the Bullard Laryngoscope (BL).


A rigid cervical collar was used to simulate the difficult airway. The study consisted of two phases. Phase I evaluated the BL used in conjunction with an independently styletted endotracheal tube (ISETT) passed freehand into the trachea. Phase II evaluated the new Multifunctional Intubating Stylet (MFIS). Forty patients were studied in each phase. Following induction of anesthesia a rigid cervical collar was applied and the laryngoscopic grade assessed. Tracheal intubation was then performed using the BL with either an ISETT or the MFIS. The total time to intubate, number of attempts, failures, hemodynamic changes during intubation were recorded.


The rigid collar effectively simulated a difficult laryngoscopy, 65% of patients had a grade 3 view. The success rates for tracheal intubation using the ISETT and MFIS were 88% and 83% respectively. The average times to intubation were similar for both intubating techniques (45.4 ± 26.8 sec for the ISETT and 41.2 ± 25.2 sec for the MFIS). Although there were minor hemodynamic changes, mucosal bleeding and sore throat following intubation, there were no major complications in any of the study patients.


The BL, used with either an ISETT or the MFIS, is an effective and safe intubating device for patients with simulated restricted cervical spine movement. Further studies are needed to compare the effectiveness and safety of these two techniques in managing patients with a difficult airway.


Tracheal Intubation Sore Throat Mouth Opening Difficult Airway Direct Laryngoscopy 
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Évaluer l’utilité et la sécurité de l’intubation orotrachéale de patients adultes, chez qui on a simulé une altération des voies aériennes, en utilisant un laryngoscope de Bullard (LB).


Un collier cervical rigide a été utilisé pour simuler l’intubation difficile. Quarante patients ont participé à chacune des deux phases de l’étude: pendant la phase I, on a évalué le LB utilisé en conjonction avec un tube endotrachéal à stylet indépendant (TETSI) passé à main libre dans la trachée; pendant la phase II, on a évalué le nouveau stylet d’intubation multifonctionnel (SIMF). Après l’induction de l’anesthésie, on a appliqué un collier cervical rigide et coté la laryngoscopie. On a procédé ensuite à l’intubation en utilisant le LB soit avec le TETSI, soit avec le SIMF. Le temps total nécessaire pour procéder à l’intubation, le nombre d’essais, les échecs et les changements hémodynamiques qui se sont produits pendant l’intubation ont été notés.


Le collier rigide a efficacement simulé des difficultés d’intubation, 65% des patients présentant une classe 3. Les taux de réussite de l’intubation endotrachéale avec le TETSI ou le SIMF ont été de 88% et 83% respectivement. Les deux techniques d’intubation ont nécessité des temps similaires (45,4 ± 26,8 s avec le TETSI et 41,2 ± 25,2 s avec le SIMF). Des changements hémodynamiques mineurs sont survenus, un saignement de la muqueuse et une irritation de la gorge après l’intubation, mais aucune complication importante.


Le LB, utilisé avec un TETSI ou le SIMF est un dispositif d’intubation efficace et sécuritaire pour les patients dont les mouvements simulés de la colonne cervicale sont limités. Des études supplémentaires sont cependant nécessaires pour comparer l’efficacité et la sécurité de ces deux techniques chez des patients pour qui l’intubation est difficile.


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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • Kirk MacQuarrie
    • 1
  • Orlando R. Hung
    • 1
  • J. Adam Law
    • 1
  1. 1.Department of AnesthesiaDalhousie University, Queen Elizabeth II Health Sciences CentreHalifaxCanada

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