MD., DA., DNB., PhD., FICA.,IDRA., Dip. Software based statistics Laryngoscope Dr S.Parthasarathy MD., DA., DNB., PhD., FICA.,IDRA., Dip. Software based statistics

Scope – visualisation To see larynx ! Colonoscope Sinuscope ! Put the tube See the larynx Remove FB

Types of laryngscopes Direct line of sight devices – rigid lighted retractors, such as the Macintosh laryngoscope, are reliant on retracting tissues to create an uninterrupted sight line between the operator and the objective. Fibreoptics may be used in the light source of these types. This is the traditional (and still routine) technique used for the vast majority of tracheal intubations. It is termed ‘direct laryngoscopy’.

Indirect Indirect line of sight devices – optical laryngoscopes, where a fibreoptic bundle, and/or series of lenses, prisms or mirrors, or now even a minature camera, transmits an image to the user from the distal end of the device View may be around Fibreoptics may be for both Optical can also be rigid

Mostly right angle with blade but Four positions are possible Blade and handle ! The handle is the part held in the hand during use. It provides the power for the light. Most often, disposable batteries are the power source. Handles with rechargeable batteries are available- Mostly right angle with blade but Four positions are possible

Various sizes Short handles for large chest , breast , cricoid Rough for grip Batteries Blade first and attach !

The base is the part that attaches to the handle The base is the part that attaches to the handle. It has a slot for engaging the hinge pin of the handle. The end of the base is called the heel.

Blade The blade is the component that is inserted into the mouth Sizes described 0 to 4 Separately inserted rarely

The tip (beak) contacts either the epiglottis or the vallecula and directly or indirectly elevates the epiglottis. It is usually blunt and thickened to decrease trauma. The blade may have a lamp (bulb).. lamp screws into a socket that has a metallic contact..

The flange projects off the side of the tongue and is connected to it by the web. It serves to guide instrumentation and deflect tissues from the line of vision. The flange determines the cross-sectional shape of the blade. The vertical height of the cross-sectional shape of a blade is sometimes referred to as the step

Tongue – gentle curve Reverse Z Cervical spine movement is greater with the Macintosh blade compared with the Miller blade, a lightwand, or the GlideScope

Left sided macintosh The left-handed (reversed) Macintosh blade has the flange on the opposite side from the usual Macintosh blade This blade may be useful for abnormalities of the right side of the face or oropharynx, left-handed intubators, individuals with limited use of the left arm, intubating in the right lateral position, or positioning a tracheal tube directly on the left side of the mouth

England ( chota flange)

Improved vision macintosh laryngoscope Concavity in spatula

Oxiport macintosh laryngoscope See the oxygen port

Tull macintosh Laryngoscope with suction port

The concept is line of vision in the base of the tongue

Macintosh Vs Miller Macintosh less traumatic to the teeth and to provide more room for passage of the tracheal tube through the oropharynx. the Miller provides a better view of the glottis in a patient with a long, floppy epiglottis, or an anterior larynx. Therefore, this laryngoscope is preferred in infants, pediatric patients, and patients with an anterior larynx 

Less sympathetic stimulant Less systolic and diastolic BP rise with macintosh than miller Better to learn laryngoscopy with macintosh But 3 % failure even with good hands

After we go for blind example bougie guided , it may be 33 % failure rate Think of straight blades

Physical or physiological Dental injury 3 – 12 % Tongue injury upto 1 % Bleeding so many variations – upto 5 % Lingual and hypoglossal nerve injuries – 0.1 % Cant see larynx – 3 % Physical or physiological

Don't use teeth as fulcrum A tooth or prosthetic device may be chipped, broken, loosened, or avulsed. May be weakened through periodontal disease, but sound teeth may also be affected upper incisors are most frequently involved . This is most often caused by using the teeth as a fulcrum point for the laryngoscope while elevating the epiglottis

The other complications Foreign body aspiration – the bulb can go in ! If a laryngoscope light that is left ON contacts the patient, a burn may result - possible short circuit The most common laryngoscope malfunction is light failure Disease transmission Infection with Listeria monocytogenes and Pseudomonas aeruginosa 

Sterilization Autoclave Detergent wash Betadine wash Only handles Beware to remove batteries

Pictures from the internet for closed academic purpose on;ly A mac – higher flange and ends a few cm before the tip

Fibre lighted macintosh

Yellow is insulation

Summary What is it Uses Types Parts of macintosh Advantages and disadvantages

Thank you all