The straight blade, or Miller blade, was introduced by Robert Miller in 1941, and 2 years later, Macintosh introduced the curved or Macintosh blade. The blade lifted the tongue out of the way, and the light bulb illuminated the glottic structures. These early laryngoscopes consisted of a metal spatula with a light bulb on the tip. Shortly thereafter, laryngoscopes were invented, allowing for direct visualization of the larynx. Product Information Type Macintosh (MAC), Disposable Size MAC2 (Pediatric/Child) Measurements 110 x 29 x 13 (mm) Shelf Life 2 years Disposable, single-use Individually packaged and hermetically sealed Quick and Easy Installation insert/remove from handle within seconds Additional Macintosh blade sizes are When the concept of orotracheal intubation was developed, more than 100 years ago, the procedure was performed blindly using palpation to identify the laryngeal inlet and guide the tube into the trachea.
Laryngoscope blades range in size from 00 for the extremely premature.T1 - Pediatric laryngoscope blade size selection using facial landmarks. This chapter reviews the most important and well-studied video laryngoscopes currently available on the market.(See Emergency airway management in children: Unique pediatric considerations.). There have been several video laryngoscopes introduced over the past few years. The use of a video laryngoscope also makes it possible to record the procedure to provide an excellent teaching resource and documentation for the medical record. Furthermore, video laryngoscopy can enhance education by allowing other health care providers to visualize the anatomy, and perhaps guide and offer assistance during the process of intubation. Third, some video laryngoscopes have an exaggerated anterior angulation of the blade and this, along with the placement of the video camera, allows the operator to see structures that would be difficult or impossible to see under direct vision.
Currently, there are two baton sizes and four blade sizes available (GVL Stat sizes 1 to 4). The monitor has similar dimensions to the original unit but has the benefit of a built-in tutorial as well as image and video clip acquisition that can be stored on a removable memory card. A new version, the Cobalt Advanced Video Laryngoscope (AVL), uses a high-definition video baton and digital video display ( Fig. The original Cobalt uses the same color video LCD monitor as the GVL and is used in identical fashion as the original GlideScope. The Cobalt video baton may connect to either of two different video displays. The Cobalt consists of a flexible video baton housing the micro-video camera that inserts into a disposable clear plastic protective blade, called the Stat.
It uses a 3.5-in (9 cm) LCD screen that allows good image clarity even when used outdoors. It is operational in a wide variety of temperatures, humidity, and altitudes and weighs roughly 2 lb (0.9 kg), making it very portable. Order)The GlideScope Ranger is a rugged, portable, battery-operated GlideScope unit designed for field use ( Fig. The primary advantage of the Cobalt is its single-use design—eliminating the logistical problems, costs, and downtime associated with high-level disinfection of the traditional GlideScope.Besdata video laryngoscope set with 6 sizes blade reusable laryngoscope for clinical adult and pediatric intubation US 1200-1500 / Piece 1.0 Pieces (Min. The Cobalt blade is angled slightly more steeply than the original design.
The GlideScope Ranger is contained within a soft-sided case with belt attachments for ease of use and mobility. The rechargeable lithium polymer battery provides 90 minutes of continuous use. The video camera is positioned approximately halfway along the blade to protect the lens from contamination, including secretions, blood, and vomitus. It also incorporates the antifogging system to maintain a clear view of the airway at all times.
As soon as the tip of the laryngoscope blade passes the teeth, the operator should direct his or her attention to the video monitor and use the landmarks on the video screen to navigate to the glottic aperture. It is difficult to identify landmarks if the blade is off the midline. There is no sweepingOf the tongue to the left as is done with conventional laryngoscopy. The critical point here is to keep the handle in the midline as you enter further into the mouth, noting key midline structures, such as the uvula, as you advance. The handle is grasped with the left hand, in the same fashion as a conventional laryngoscope, and the tip of the laryngoscope blade is gently inserted into the mouth, in the midline, under direct vision. Similar to the Cobalt, the Ranger Single Use has two different-sized batons and variably sized Stats.The GlideScope is used in the following manner to perform tracheal intubation ( Box 13-1 and Fig.
If the glottic view is insufficient, often a gentle tilt of the handle will expose it fully, in contrast to the lifting motion with a conventional laryngoscope. The blade should ultimately be seated in the vallecula, much in the same way that a Macintosh blade is used. At that point, it is best to continue advancing the blade into the vallecula, with some gentle upward force, to lift the epiglottis out of the way. The operator should then continue to gently advance the blade down the tongue and past the uvula, with a slight elevating motion until the epiglottis is seen.
When the tube is placed where desired, the operator again views the video monitor to guide advancement of the tube to the glottis. When an optimal glottic view (almost 100% of GVL views are either grade I or grade II) is obtained, the operator again looks into the mouth, to insert the ETT, with a stylet curved to match the curve of the GVL blade, alongside the blade. This motion can tilt the larynx more sharply, making advancement of the tube into the trachea technically more challenging.
Negotiating the oropharynx and traversing the glottis with an acutely shaped ETT can be somewhat technically difficult for two reasons. However, advancing the ETT toward the image of the glottis displayed on the video screen can still be challenging. For two of these steps, the operator is viewing the video monitor for the other two, the operator is looking into the patient’s mouth (see Box 13-1).Identifying and exposing the glottis generally is easy using the GlideScope.
When the tube is felt to be well positioned, that is, proximate and parallel to the blade, the operator looks at the screen and advances the tube along its curved axis to guide it to the laryngeal inlet with the curvature heading anteriorly toward the airway. Under direct vision, the operator places the tip of the ETT in the corner of the right side of the patient’s mouth with the tube nearly parallel to the ground (operator’s hand at the 2- to 3-o’clock position) and advances the tube into position alongside the GVL blade. The critical factor in getting the tube to enter the trachea is configuring the ETT into a shape that conforms to that of the GlideScope blade so that the ETT is able to follow the sameTrajectory as the blade. The second issue is that using the screen to navigate to the glottis requires a form of hand-eye coordination that is different from traditional direct laryngoscopy.
If the tube continues to impinge on the anterior trachea, the GlideScope can be withdrawn about 2 cm, causing the larynx to drop down, lessening the angle of approach and thus greatly facilitating further advancement of the tube. The manufacturer of the GVL has recently released the GlideRite Auto Stylet, which has a mechanism to withdraw the stylet and advance the ETT with the simple push of a button on the stylet. Withdrawal of the stylet may be done by an assistant or by the intubator, particularly if using the proprietary stylet as it has a flange designed to be actuated by the operator’s thumb. When the glottis is entered, the stylet is withdrawn 2 cm to reduce the rigidity of the sharply angulated distal tip of the tube, facilitating advancement into the trachea. If this stylet is not available, a malleable stylet can be shaped into a similar 60° curve.
Using a soft tapered tip ETT, such as the proprietary Parker ETT, can help overcome this issue and facilitate intubation by easing entry of the tube through the glottic inlet.
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