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OSCE 464: Laryngoscopes

Introduction

Regarding laryngoscopes…

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Question No. 2

Q: What are the labelled components of the laryngoscope blade? (5 marks)

Answer No. 2

Spatula 1
(Tongue)
  • The main part of the blade which may be straight or curved
  • Passes over the lingual surface of the tongue
Flange 1
  • The portion of the blade that arises from the edge of the spatula
  • Used to direct and compress the tongue and other tissue to reveal the cords
  • Size and shape varies significantly with different blade designs
Web 1
  • Connects the flange to the spatula
Tip 1
(Beak)
  • Contacts the vallecula to directly or indirectly elevate the epiglottis
  • Is usually blunt and thickened to prevent trauma
Base 1
  • Attaches the blade to the handle
  • Has a notch to engage with the hinge pin of the handle

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Question No. 3

Q: What type of laryngoscope is this? (1 marks)

Answer No. 3

Macintosh 1
  • The most commonly used blade in the UK
  • A gentle curve from the tip to the proximal end
  • Large 'reverse-Z' flange designed to sweep the tongue to the left of the mouth
  • Light source pierces the blade towards the tip so as not to interfere with the view

1

Question No. 4

Q: What type of laryngoscope is this? (1 marks)

Answer No. 4

Robertshaw 1
  • Gently curved over the distal third
  • Designed to indirectly lift the epiglottis like a Macintosh blade
  • Generally used in infants and children
  • Allows binocular vision by removing the lateral flange

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Question No. 5

Q: What type of laryngoscope is this? (1 marks)

Answer No. 5

Miller 1
  • The most commonly used straight blade in the UK
  • The small tongue does not allow a sweep of the tongue but is designed to be directed along the right side of the mouth and re angled once passed the base of tongue

1

Question No. 6

Q: Describe 2 disadvantages of straight blades? (2 marks)

Answer No. 6

Type
Description
Advantages & Disadvantages
Curved Blade
Designed to lift the epiglottis indirectly and provide a view of the laryngeal opening by placing the tip over the epiglottis into the vallecula and exerting pressure on the hypoepiglottic ligament
  • Less traumatic
  • Less stimulating
  • Provides better view in patients with big tongues
Straight Blade
Designed to be placed under the epiglottis and lift it directly to provide a view of the laryngeal opening
  • More traumatic 1
  • More stimulating due to contact with epiglottis 1 - can trigger tachycardia and arrythmias
  • Provides better view in patients with long, floppy or anterior epiglottis (neonates, infants and children)

2

Question No. 7

Q: How should reusable laryngoscopes be cleaned? (2 marks)

Answer No. 7

  • Single-use laryngoscope blades are encouraged:
    • Not been shown to be associated with an increased risk of complications
    • Use can be economical when sterilisation costs considered
  • If reusable laryngoscopes are used:
    • Blades should be sterilised by a regulated sterile supply department between uses 1
    • Handles should be disinfected or sterilised between uses 1
  • If video laryngoscopes are used:
    • Single-use blades are encouraged
    • Decontamination of reusable components must happen after each use in a standardised manner
  • Care should be taken to place used scopes in a designated receptacle after use to prevent contamination
AAGBI Guidelines

G

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Question No. 8

Q: Outline the Cormack and Lehane grades of view at laryngoscopy? (2 marks)

Answer No. 8

Grade
Description
I
All of glottis visible 0.5
II
Portion of anterior glottis not visible 0.5
III
Only epiglottis visible 0.5
IV
Epiglottis not visible 0.5

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Case Information

Your department buys a new indirect laryngoscope. It is a non-guided videolaryngoscopes…

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Question No. 10

Q: Describe 3 advantages of indirect laryngoscopes? (3 marks)

Answer No. 10

Advantages
  • Improved laryngeal visualization 1
  • Improved intubation success 1
  • Greater portability than fibreoptic scopes 1
  • Reduced trauma 1
  • Reduced force required 1:
    • Results in less cervical spine movement
    • Less haemodynamic stress
  • Easy to learn 1
  • Useful in airway training 1:
    • Allows concurrent view by observer

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Question No. 11

Q: Describe 3 disadvantages of indirect laryngoscopes? (3 marks)

Answer No. 11

Disadvantages
  • Difficulty in inserting tube despite good view 1:
    • Often Requires bougie or stylet
  • Reduced skill in ‘gold standard’ technique of direct laryngoscopy 1
  • Increased cost over standard laryngoscopes 1
  • Large handle can be difficult to insert in pregnant or obese patients 1

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