ALL YOU NEED TO KNOW ABOUT LARYNGOSCOPY
Hey there! If you are a medical student, a medical trainee, or going to be a health care provider and intend to gain information about Laryngoscopy than you have reached just to the right place.
What is laryngoscopy?
Health care providers sometimes use small medical devices to look into the throat, larynx (voice box), the vocal cord, and as well as nearby structures.
There are several types of laryngoscopy:
- Indirect laryngoscopy
- Direct fiber-optic laryngoscopy
- Direct laryngoscopy
But here we will discuss direct laryngoscopy.
What is direct laryngoscopy?
In a direct laryngoscopy, health care provider uses a laryngoscope and push down the tongue and lifts up the epiglottis, examine the larynx or to remove small cancers or tumors, tissue samples for testing or to insert an ETT into the windpipe. Direct laryngoscopy is done with the patient under general anesthesia.
What are the reasons to perform laryngoscopy?
There are several reasons to perform laryngoscopy:
- To simply look into the throat and voice box for any problem associated with the throat.
- For removal of something stuck in the throat.
- To obtain a biopsy sample.
- For the treatment of diseases related to throat (e.g. to remove cancers or tumors)
- To intubate the patient during emergency or surgery to help them to breathe
What is a Laryngoscope?
The word laryngoscope is composed of two words (Greek word>laryngo which means pertaining to the throat, the upper part of the windpipe.) and (scope a combining form which means “an instrument for viewing”)
And here’s the combined definition:
A Laryngoscope is an instrument equipped with a source of battery power and a light for examining the larynx or for difficult intubation (difficulty in passing an Endo-tracheal tube through the larynx.)
What are the components of a laryngoscope?
A laryngoscope consists of two components:
The handle is made of chrome-plated metal.
It contains a battery power source (replaceable batteries) and a LED light or bulb.
It is cylindrical in shape and is for holding purposes
The blade contains the light source.
The base (hook) of the blade attaches to the handle and makes an electrical connection when extended and produces light.
The blade can be curved or straight with a beveled tip.
The blade is placed inside the mouth and then forwarded to the patient’s throat to obtain a complete view of the throat.
What are the types of laryngoscope blades?
There are many different types of blades that you may have seen or find on other websites while searching. But these 3 types are most widely being used recently across the world.
What is Macintosh Blade?
Macintosh blade was invented by Sir Robert Reynolds Macintosh, an eminent Anesthetist of New Zealand, and was developed by his assistant Richard Salt Macintosh in the year 1943. It is the most widely used type of curved blades. When it is placed in the throat, it directly opens the epiglottis by applying pressure to the epiglottic vallecula (an anatomic term used for the place just behind the root of the tongue.)
It comes in sizes 0 to 4.
- Size 0, 1 & 2 for children. (neonates, infant, and toddlers)
- & Size 3 for adult female.
- Size 4 for an adult male.
What is McCoy blade?
McCoy blade was invented in the year 1993 and is the modified type of curved blades. It is just like the Macintosh blade but with a moveable or flexible tip. It contains a lever adjacent to the handle which allows control of the flexible tip. The flexible tip allows the direct elevation of the epiglottis and an increased view of the larynx. Due to its modification, less force is required to displace the epiglottis during difficult intubation and less force means fewer chances of trauma.
It comes in sizes 2, 3, 4.
- Size 2 for children.
- While Size 3 for an adult female.
- Size 4 for an adult male.
What is a Miller blade?
Miller blade was invented by Robert A. Miller in the year 1941. It is the most popular type of straight blades with a slightly curved tip. It depresses the tongue and directly lifts the epiglottis and provides a better view of the vocal cords. Miller blade is most commonly used in infants because it is easy to visualize the glottis by using this blade than the Macintosh blade, due to their larger size of epiglottis than the glottis.
It comes in sizes 0 to 4.
Sizes 0, 1 & 2 for children. (neonates, infants, toddlers)
03 size is used for adult females.
04 size is used for adult males.
- Blade type and blade size are chosen by the health care provider accordingly to the patient’s age, weight and anatomical need.
How to perform laryngoscopy?
To perform a perfect laryngoscopy, the health care provider must know and follow these techniques:
The health care provider will position the patient to sniff position (lying straight with head tilt chin lift).
After positioning the patient, the health care provider must stand behind the patient’s head side, holding the laryngoscope in the left hand.
2. Mouth opening technique
The health care provider will open the patient’s mouth using a scissor maneuver technique with the right hand (right finger on the patient’s upper jaw and middle finger on the lower jaw.)
3. Performing laryngoscopy
The health care provider will place the laryngoscope to the right side of the mouth and swipe the tongue to the left side of the mouth with the help of a laryngoscope. And then pull the laryngoscope forward and upward at 45 degrees from the horizontal line to displace the epiglottis.
After that, the health care provider will place the ETT with the right hand into the windpipe through the vocal cords and fix the tube with sticking tape and remove the laryngoscope.
What possible complications might happen during or after laryngoscopy?
It’s rare to have problems after laryngoscopy, but it can still happen if not handled with care. Some of the complications may include:
- Swelling or pain in the tongue, mouth, or throat.
- Trauma or bleeding.
- Dislocation or chipping of teeth.
- Gagging or vomiting.
How to clean a laryngoscope?
After performing laryngoscopy health care providers must clean their laryngoscopes to avoid the spread of infections.
Mentioned below are the steps to clean a laryngoscope:
- Detach the blade from the handle.
- Clean the handle by using a spirit swab or any alcoholic swab and then put it in a clean place.
- Rinse the blade with water.
- Scrub the blade thoroughly by using a soft bristle brush, and rinse again thoroughly with running tap water to remove all residual detergent.
- Dry the blade with a clean sterilized cloth or filtered pressurized air.
- Put in the autoclave after the cleaning process to completely kill all possible germs.