II. Preparation: Estimated blade size selection
- With Laryngoscope Blade held next to patient's face
- Blade should reach between lips and Larynx (or lips to angle of jaw)
- Similar distance as with sizing Oral Airway
- Better to choose a blade too long than too short
- Estimate 1 cm longer than needed
-
Video Laryngoscopy Blade (e.g. Glidescope)
- Size 3 Glidescope disposable blade fits most adults (even large adults)
- Size 4 Glidescope disposable blade is typically difficult to fit inside the mouth
III. Preparation: Blade size guidelines by age
- Adult: #3 to #4 Macintosh Blade (curved)
- Video Laryngoscope blade sizes vary widely (e.g. Glidescope #3 fits most patients, including large males)
- Child
- Consider a wider Laryngoscope Blade in syndromic children (e.g. Macroglossia)
- Miller blade (straight blade) used most often in infants and young children
- Keeps the large floppy epiglottis out of the way
- Miller blade #0
- Miller blade #1
- Term infant
- Miller blade #2
- Age 2 years old
- Miller blade #3
- Third grade (age 9 years old)
- Macintosh Blade #2 (curved)
- Child at age 8
IV. Preparation: Pearls
- Airway needs repositioning (e.g. BURP Technique) in 80% of cases
- High intensity light sources on Laryngoscopes are critical to adequate visualization
- Best sources approach 10,000 LUX
- LED light sources are preferred
- Disposable Direct Laryngoscope Blade and Handle
- Consider as back-up in Emergency Kit
V. References
- Levitan (2013) Practical Airway Management Course, Baltimore