Laryngoscope and blades
Reviewed and revised 3 April 2015
OVERVIEW
- device used to visualise the vocal cords to facilitate intubation
USE
- visualisation the vocal cords to allow insertion of an endotracheal tube
- also useful for insertion of a gastric tube or TOE probe by lifting the larynx forwards.
DESCRIPTION
- Base of blade (attaches to handle and makes an electrical connection when extended)
- Hook of blade
- Curved or Straight blade
- Flange (containing web and light source) – proximal flange to sweep the tongue aside
- Tip
- Handle tip containing electrical connection and connection for hook
- Green line
- Handle containing batteries
METHOD OF INSERTION/ USE
- see direct laryngoscopy
- with a curved blade the tip is placed in the vallecula behind the epiglottis
- with a straight blade the tip is used to lift the epiglottis directly to reveal the cords (useful in paediatrics as small children have long floppy epiglottis)
COMPLICATIONS
- Soft tissue injury and upper airway haemorrhage
- dislodgement or chipping of teeth
- laryngospasm
- failure to perform procedure
- light source failure
OTHER INFORMATION
Handles
- Standard size handle
- Short handle — useful for short necks, barrel chests and large breasts such as obstetric or obese patients (often with a Kessel blade)
- Penlight — thinner diameter, works better with smaller blades
Blades
- Various types of blades
— Macintosh (commonest; blade attaches to handle at 90 degrees)
— Kessel (like the Macintosh but the blade attaches at 110 degrees)
— McCoy (Macintosh like blade with a moveable distal tip segment, flexed by a lever controlled by the thumb of the hand holding the handle to displace the larynx forwards)
— Magill (straight blade with U-shaped cross section)
— Miller and Wisconsin blades (straight blades with curved tips) - Disposable metal and plastic blades available
- Right-handed blades available for left handed people
References and Links
LITFL
- Sir Ivan Whiteside Magill (1888 – 1986)
- Sir Robert Reynolds Macintosh (1897 – 1989); Macintosh laryngoscope
- Robert Arden Miller (1906 – 1976); Miller laryngoscope
Journal articles
- Kessell J. A laryngoscope for obstetrical use an obstetrical laryngoscope. Anaesth Intensive Care. 1977 Aug;5(3):265-6. PubMed PMID: 900469.
- Scott J, Baker PA. How did the Macintosh laryngoscope become so popular? Paediatr Anaesth. 2009 Jul;19 Suppl 1:24-9. doi: 10.1111/j.1460-9592.2009.03026.x. Review. PubMed PMID: 19572841.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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