Procedure

Direct Laryngoscope

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Direct Laryngoscope, Laryngoscope, Laryngoscope Handle, Laryngoscope Blade, Straight Laryngoscope Blade, Miller Laryngoscope Blade, Curved Laryngoscope Blade, Macintosh Laryngoscope Blade

  • See Also
  1. Advanced Airway
  2. Rapid Sequence Intubation
  3. Endotracheal Intubation Preparation
  4. Endotracheal Tube
  5. Endotracheal Intubation Preoxygenation (and Apneic Oxygenation)
  6. Video Laryngoscope
  7. Endotracheal Intubation
  8. Extraglottic Device (e.g. Laryngeal Mask Airway or LMA)
  9. Tactile Orotracheal Intubation (Digital Intubation)
  10. Nasotracheal Intubation
  11. Cricothyrotomy
  12. Needle Cricothyrotomy
  • Preparation
  • Estimated blade size selection
  1. With Laryngoscope Blade held next to patient's face
    1. Blade should reach between lips and Larynx (or lips to angle of jaw)
    2. Similar distance as with sizing Oral Airway
  2. Better to choose a blade too long than too short
    1. Estimate 1 cm longer than needed
  3. Video Laryngoscopy Blade (e.g. Glidescope)
    1. Size 3 Glidescope disposable blade fits most adults (even large adults)
    2. Size 4 Glidescope disposable blade is typically difficult to fit inside the mouth
  • Preparation
  • Blade size guidelines by age
  1. Adult: #3 to #4 Macintosh Blade (curved)
    1. Video Laryngoscope blade sizes vary widely (e.g. Glidescope #3 fits most patients, including large males)
  2. Child
    1. Consider a wider Laryngoscope Blade in syndromic children (e.g. Macroglossia)
    2. Miller blade (straight blade) used most often in infants and young children
      1. Keeps the large floppy epiglottis out of the way
    3. Miller blade #0
      1. Premature Infant
    4. Miller blade #1
      1. Term infant
    5. Miller blade #2
      1. Age 2 years old
    6. Miller blade #3
      1. Third grade (age 9 years old)
    7. Macintosh Blade #2 (curved)
      1. Child at age 8
  • Preparation
  • Pearls
  1. Airway needs repositioning (e.g. BURP Technique) in 80% of cases
    1. De Jong (2014) Intensive Care Med 40(5): 629-39 [PubMed]
  2. High intensity light sources on Laryngoscopes are critical to adequate visualization
    1. Best sources approach 10,000 LUX
    2. LED light sources are preferred
  3. Disposable Direct Laryngoscope Blade and Handle
    1. Consider as back-up in Emergency Kit
  • References
  1. Levitan (2013) Practical Airway Management Course, Baltimore