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SOE 654: Laryngoscopes

Introduction

The following questions relate to laryngoscopes…

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Question No. 2

Q: How can you classify laryngoscopes?

Answer No. 2

Direct Laryngoscopes
  • Straight Blade
  • Curved Blade
Indirect Laryngoscopes
  • Rigid Blade
  • Integrated channel laryngoscopes
  • Video Stylet

Question No. 3

Q: What is the difference between straight and curved laryngoscope blades?

Answer No. 3

Type
Description
Advantages & Disadvantages
Curved Blade
Designed to be placed under the epiglottis and lift it directly to provide a view of the laryngeal opening
  • More traumatic
  • More stimulating due to contact with epiglottis - can trigger tachycardia and arrythmias
  • Provides better view in patients with long, floppy or anterior epiglottis (neonates, infants and children)
Straight 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

Question No. 4

Q: What type of laryngoscope blade is this?

Answer No. 4

Macintosh blade

Question No. 5

Q: Can you draw a cross-section half-way down the blade?

Answer No. 5

Question No. 6

Q: What are the components of the laryngoscope blade that you can identify and describe?

Answer No. 6

Spatula
(Tongue)
  • The main part of the blade which may be straight or curved
  • Passes over the lingual surface of the tongue
Flange
  • 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
  • Connects the flange to the spatula
Tip
(Beak)
  • Contacts the vallecula to directly or indirectly elevate the epiglottis
  • Is usually blunt and thickened to prevent trauma
Base
  • Attaches the blade to the handle
  • Has a notch to engage with the hinge pin of the handle

Question No. 7

Q: What type of laryngoscope blade is this?

Answer No. 7

Miller blade

Question No. 8

Q: Can you draw a cross-section half-way down the blade?

Answer No. 8

Question No. 9

Q: Which type of patients is this commonly used on and why?

Answer No. 9

  • Commonly used in neonates, infants and children
  • Provides better view in patients with long, floppy or anterior epiglottis 

Question No. 10

Q: What type of laryngoscope blade is this?

Answer No. 10

McCoy blade

Question No. 11

Q: What is different about the McCoy blade? When/why do we use it?

Answer No. 11

  • A modification of a Macintosh blade
  • Has a hinged tip which can be lifted using the lever attached to the handle
  • Designed to lift the epiglottis with less force than a standard mackintosh
  • Can be useful in achieving a better view than a standard Macintosh blade particularly in cervical spine injury

Question No. 12

Q: What types of light source can be used with laryngoscopes? What are their features?

Answer No. 12

Standard Light Source
(Colour Coded Black)
  • Contains a small bulb near the distal end of each blade
  • Handle contains the batteries only
  • Bulbs can be standard filament or LED
  • Filament bulbs can cast small central shadow
  • Bulbs generate heat and risk of thermal transmission to patient with standard bulbs (not with LEDs
Fibreoptic Light Source
(Colour Coded Green)
  • Contains the bulb and batteries in the handle
  • Transmitted to the blade through a fibreoptic column
  • Avoids the risk of heat transmission
  • Can allow for brighter bulbs to be used
  • Disposable blades more economical

Question No. 13

Q: What are the infection control concerns with laryngoscopes?

Answer No. 13

  • Well recognised source of cross-contamination:
    • High-risk instruments, regularly contaminated with blood
    • Have been implicated as possible transmitters of CJD
  • Both the handle and blade can become contaminated during use

Question No. 14

Q: How can infection concerns be overcome?

Answer No. 14

  • 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
    • Handles should be disinfected or sterilised between uses
  • 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

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