II. 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

III. 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

IV. 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

V. References

  1. Levitan (2013) Practical Airway Management Course, Baltimore

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Related Studies

Ontology: Laryngoscopes (C0180453)

Definition (UMD) Respiratory tract endoscopes designed for direct insertion through the mouth into the air tract for visual examination, biopsy, and treatment of lesions of the larynx; they are also used for intubation of the trachea. Laryngoscopes are available either as rigid or flexible devices. Some laryngoscopes are designed specifically for use in magnetic resonance imaging [MRI] environments, i.e., MRI-compatible laryngoscopes, and are made from nonmagnetic materials so that they can be safely used in an MRI suite.
Definition (NCI) A device used to directly visualize the larynx; often has a battery-powered lamp at its tip.
Definition (NCI_NCI-GLOSS) A thin, tube-like instrument used to examine the larynx (voice box). A laryngoscope has a light and a lens for viewing and may have a tool to remove tissue.
Definition (SPN) A nasopharyngoscope (flexible or rigid) and accessories is a tubular endoscopic device with any of a group of accessory devices which attach to the nasopharyngoscope and is intended to examine or treat the nasal cavity and nasal pharynx. It is typically used with a fiberoptic light source and carrier to provide illumination. The device is made of materials such as stainless steel and flexible plastic. This generic type of device includes the antroscope, nasopharyngolaryngoscope, nasosinuscope, nasoscope, postrhinoscope, rhinoscope, salpingoscope, flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biospy brush, rigid biopsy forceps and flexible biopsy curette, but excludes the fiberoptic light source and carrier.
Definition (SPN) An endoscope and accessories is a device used to provide access, illumination, and allow observation or manipulation of body cavities, hollow organs, and canals. The device consists of various rigid or flexible instruments that are inserted into body spaces and may include an optical system for conveying an image to the user's eye and their accessories may assist in gaining access or increase the versatility and augment the capabilities of the devices. Examples of devices that are within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes, flexible or rigid choledochoscopes, colonoscopes, diagnostic cystoscopes, cystourethroscopes, enteroscopes, esophagogastroduodenoscopes, rigid esophagoscopes, fiberoptic illuminators for endoscopes, incandescent endoscope lamps, biliary pancreatoscopes, proctoscopes, resectoscopes, nephroscopes, sigmoidoscopes, ureteroscopes, urethroscopes, endomagnetic retrievers, cytology brushes for endoscopes, and lubricating jelly for transurethral surgical instruments. This section does not apply to endoscopes that have specialized uses in other medical specialty areas and that are covered by classification regulations in other parts of the device classification regulations.
Definition (MSH) Endoscopes for examining the interior of the larynx.
Concepts Medical Device (T074)
MSH D020704
SnomedCT 44738004
English Laryngoscopes, Larynx Endoscopes, Laryngoscope, device, laryngoscope, laryngoscopes, LARYNGOSCOPE, ENDOSCOPE, LARYNGOSCOPE, NASOPHARYNGOSCOPE, Laryngoscope, Laryngoscope, device (physical object)
Czech laryngoskopy
Finnish Kurkunpääntähystimet
Swedish Laryngoskop
French Laryngoscopes
Polish Laryngoskopy
Norwegian Laryngoskop
Spanish laringoscopio (objeto físico), laringoscopio, Laringoscopios
German Laryngoskope
Italian Laringoscopi
Dutch Laryngoscoop, Laryngoscopen
Portuguese Laringoscópios

Ontology: Laryngoscope blade (C0563576)

Definition (UMD) Detachable distal components of a rigid laryngoscope designed to provide illumination and displace the lower pharynx, larynx, and upper trachea. These devices typically consist of a spatula to hold the tongue; an angular or curved flange to provide rigidity with an L-shaped or semicircular groove for viewing along its length; and, usually, an illumination system (using either a conventional lamp or a fiberoptic system). The blade is typically hooked onto the laryngoscope handle; it may fold for storage, simultaneously switching off the light. Laryngoscope blades are available in several sizes for adult and pediatric use; they are also available as a nonfoldable, integral part of plastic laryngoscopes. Some laryngoscope blades are designed specifically for use in magnetic resonance imaging (MRI) environments, (i.e., MRI-compatible laryngoscope blades), and are made from nonmagnetic materials so that they can be safely used in an MRI suite.
Concepts Medical Device (T074)
SnomedCT 285698002
English Laryngoscope Blades, Blades, Laryngoscope, Laryngoscope blade, Laryngoscope blade (physical object)
Spanish hoja del laringoscopio, rama del laringoscopio (objeto físico), rama del laringoscopio

Ontology: Straight laryngoscope blade (C0563578)

Concepts Medical Device (T074)
SnomedCT 285700006
English Straight laryngoscope blade, Straight laryngoscope blade (physical object)
Spanish hoja de laringoscopio rígido, rama de laringoscopio rígido (objeto físico), rama de laringoscopio rígido

Ontology: Curved laryngoscope blade (C0563579)

Concepts Medical Device (T074)
SnomedCT 285701005
English Curved laryngoscope blade, Curved laryngoscope blade (physical object)
Spanish hoja curva de laringoscopio (objeto físico), hoja curva de laringoscopio

Ontology: Macintosh laryngoscope blade (C1531939)

Concepts Medical Device (T074)
SnomedCT 414632000
English Macintosh laryngoscope blade (physical object), Macintosh laryngoscope blade
Spanish hoja de laringoscopio tipo Macintosh, rama de laringoscopio tipo Macintosh (objeto físico), rama de laringoscopio tipo Macintosh

Ontology: Miller laryngoscope blade (C1532566)

Concepts Medical Device (T074)
SnomedCT 414725003
English Miller laryngoscope blade (physical object), Miller laryngoscope blade
Spanish hoja de laringoscopio Miller, rama de laringoscopio Miller (objeto físico), rama de laringoscopio Miller

Ontology: Laryngoscope handle (C1827901)

Definition (UMD) Handles designed to hold and supply power (i.e., battery) to a laryngoscope blade. These devices usually consist of a hollow handle with a battery and, usually, a battery charger. The handle and an attached standard, conventional blade compose a working laryngoscope. Dedicated fiberoptic laryngoscope handles are also available. Some laryngoscope handles are designed specifically for use in magnetic resonance imaging [MRI] environments, i.e., MRI-compatible laryngoscope handles, and are made from nonmagnetic materials so that they can be safely used in an MRI suite.
Concepts Medical Device (T074)
SnomedCT 422762003
English Laryngoscope handle (physical object), Laryngoscope handle, Handles, Laryngoscope, Laryngoscope Handles
Spanish mango del laringoscopio (objeto físico), mango del laringoscopio