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

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

3. 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’.

4. 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

5. 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

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

7. 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.

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

11. 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..

12. 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

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

15. 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

16. England ( chota flange)

17. Improved vision macintosh laryngoscope
Concavity in spatula

18. Oxiport macintosh laryngoscope
See the oxygen port

19. Tull macintosh
Laryngoscope with suction port

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

21. 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 

22. 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

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

24. 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

25. 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

26. 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 

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

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

29. Fibre lighted macintosh

30. Yellow is insulation

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

32. Thank you all