Abstract
OBJECTIVE: To compare intubation times and ease of use for a range of infant laryngoscope blades in the hands of accident and emergency (A&E) personnel. METHODS: Seven different blades were compared in terms of intubation times and ease of use scores in the hands of 30 A&E senior house officers (SHOs) and nurses using a standard infant manikin. RESULTS: There was a significant difference in intubation times between the seven blades (p < 0.001). Intubation with two blade designs (Seward and Soper) took almost twice as long as for the other blades (p < 0.05). Subjective ease of use scoring also identified the Seward and Soper blades as being the most difficult to use (p < 0.05). There were no significant differences between SHO and nurse intubation times or ease of use scoring. Successful intubation was achieved within 30 seconds in 90% of attempts. All but two of the subjects used an incorrect levering technique for intubation despite all having previously received training in infant intubation. CONCLUSIONS: No current standard exists regarding the utilisation of infant laryngoscope blades in the A&E department. The first line blade available should be a C shaped blade (Miller, Oxford, Robert-shaw, or Wisconsin). Other blade designs should be kept for use only by more experienced personnel or in difficult intubation situations. Intubation training must focus on correct technique and regular assessment is essential.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- BRYCE-SMITH R. A laryngoscope blade for infants. Br Med J. 1952 Jan 26;1(4751):217–217. [PMC free article] [PubMed] [Google Scholar]
- Hauswald M., Tuohy G. F., von der Heydt P. Adequate training for endotracheal intubation. Ann Emerg Med. 1992 Sep;21(9):1168–1169. doi: 10.1016/s0196-0644(05)80680-8. [DOI] [PubMed] [Google Scholar]
- Marks R. R., Hancock R., Charters P. An analysis of laryngoscope blade shape and design: new criteria for laryngoscope evaluation. Can J Anaesth. 1993 Mar;40(3):262–270. doi: 10.1007/BF03037039. [DOI] [PubMed] [Google Scholar]
- McIntyre J. W. Laryngoscope design and the difficult adult tracheal intubation. Can J Anaesth. 1989 Jan;36(1):94–98. doi: 10.1007/BF03010896. [DOI] [PubMed] [Google Scholar]
- POPE E. S. Left handed laryngoscope. Anaesthesia. 1960 Jul;15:326–328. doi: 10.1111/j.1365-2044.1960.tb13347.x. [DOI] [PubMed] [Google Scholar]
- Phillips O. C., Duerksen R. L. Endotracheal intubation: a new blade for direct laryngoscopy. Anesth Analg. 1973 Sep-Oct;52(5):691–698. [PubMed] [Google Scholar]
- ROBERTSHAW F. L. A new laryngoscope for infants and children. Lancet. 1962 Nov 17;2(7264):1034–1034. doi: 10.1016/s0140-6736(62)92712-5. [DOI] [PubMed] [Google Scholar]
- SIKER E. S. A mirror laryngoscope. Anesthesiology. 1956 Jan;17(1):38–42. doi: 10.1097/00000542-195601000-00006. [DOI] [PubMed] [Google Scholar]
- Schapira M. A modified straight laryngoscope blade designed to facilitate endotracheal intubation. Anesth Analg. 1973 Jul-Aug;52(4):553–554. [PubMed] [Google Scholar]
- Zideman D. A. Paediatric and neonatal life support. Br J Anaesth. 1997 Aug;79(2):178–187. doi: 10.1093/bja/79.2.178. [DOI] [PubMed] [Google Scholar]