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Year : 2012  |  Volume : 6  |  Issue : 4  |  Page : 433-434

A simple modification of pediatric and adult Macintosh laryngoscopes for oxygen insufflation


1 Intensive Care Unit, NUSI Wockhardt Hospital, Panzorconi, Cuncolim, Goa, India
2 Department of Anesthesiology, Goa Medical College, Bambolim, Goa, India

Correspondence Address:
Sidhesh S Bharne
F1/A2, Kurtarkar Vatika, Shantinagar, Ponda, Goa - 403 401
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-354X.105903

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Date of Web Publication10-Jan-2013
 


How to cite this article:
Barad D, Bharne SS, Kumar SA. A simple modification of pediatric and adult Macintosh laryngoscopes for oxygen insufflation. Saudi J Anaesth 2012;6:433-4

How to cite this URL:
Barad D, Bharne SS, Kumar SA. A simple modification of pediatric and adult Macintosh laryngoscopes for oxygen insufflation. Saudi J Anaesth [serial online] 2012 [cited 2021 Oct 16];6:433-4. Available from: https://www.saudija.org/text.asp?2012/6/4/433/105903

Sir,

We propose a simple method for pharyngeal oxygen insufflation during paediatric and adult Macintosh laryngoscopy [Figure 1]. A 06 FG size suction catheter is fixed to the laryngoscope blade in the angle between the tongue and the web using paper tape, [Figure 2] with the side hole near the tip exposed, and the tip midway between tip of the bulb and the tip of the laryngoscope blade [Figure 3]. The proximal end of the catheter is connected to the tubing of an oxygen source (e.g., auxiliary oxygen flowmeter of the anaesthesia machine), and a flow of 2-6 L/minute [1] oxygen can be used. The catheter can also be connected to a suction source for a short while to suction out oropharyngeal secretions if the need arises. This can be used for all sizes of Macintosh blades, from 0 to 5.
Figure 1: Modified Macintosh blade

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Figure 2: Angle between the web and tongue of the blade

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Figure 3: Tip of the catheter

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Many methods have been employed for oxygen insufflation during laryngoscopy using Miller blades for pediatric patients. Taped feeding tubes, [2] feeding tubes threaded through drilled holes on the blade, [1] soldered metallic hollow tubes or channels, [3],[4] and others have been used. The use of disposable suction catheters over soldered metallic channels has the advantage of ease in cleaning and sterilizing the blade. A possible disadvantage is that the adhesive tape can loosen; [2] in our experience, this can be prevented by carefully applying the tape and firmly securing the catheter. This is a simple, cost-effective alternative to the commercially available oxygen-insufflating laryngoscopes in institutions where such equipment is not available. Pharyngeal insufflation of oxygen has been shown to delay the onset of desaturation and hypoxemia during apnea. [5] Such a laryngoscope will be extremely useful in paediatric patients [6] and adult patients at risk for desaturation and hypoxemia, [7],[8] such as in obesity, pregnancy, critically ill patients, and others.

 
  References Top

1.Cork RC, Woods W, Vaughan RW, Harris T. Oxygen supplementation during endotracheal intubation of infants. Anesthesiology 1979;51:186.  Back to cited text no. 1
    
2.Wung JT, Stark RI, Indyk L, Driscoll JM. Oxygen supplement during endotracheal intubation of the infant. Pediatrics 1977;59:1046-8.  Back to cited text no. 2
    
3.Hencz P. Modified laryngoscope for endotracheal intubation of neonates. Anesthesiology 1980;53:84.  Back to cited text no. 3
    
4.Muallem M, Baraka A. Pharyngeal oxygen insufflation via the laryngoscope blade. Anaesthesia 2006;61:1015-6.  Back to cited text no. 4
    
5.Teller LE, Alexander CM, Frumin MJ, Gross JB. Pharyngeal insufflation of oxygen prevents arterial desaturation during apnea. Anesthesiology 1988;69:980-2.  Back to cited text no. 5
    
6.Ledbetter JL, Rasch DK, Pollard TG, Helsel P, Smith RB. Reducing the risks of laryngoscopy in anaesthetised infants. Anaesthesia 1988;43:151-3.  Back to cited text no. 6
    
7.Baraka AS, Taha SK, Siddik-Sayyid SM, Kanazi GE, El-Khatib MF, Dagher CM, et al. Supplementation of pre-oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation. Anaesthesia 2007;62:769-73.  Back to cited text no. 7
    
8.Roppolo LP, Wigginton JG. Preventing severe hypoxia during emergent intubation: Is nasopharyngeal oxygenation the answer? Crit Care 2010;14:1005.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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