Laryngoscopy : Time to broaden our horizon .

1. Laryngoscopy: Time to broaden our horizon. Dr RenuDevaprasath DNB (Anaesthesia)Dept of AnaesthesiaJeyasekharan HospitalNagercoilKanyakumari District

2. LARYNGOSCOPY A procedure wherein the larynx is visualized Performed for diagnostic, therapeutic & intubation purposes by various specialists.

3. LARYNGOSCOPY IN ANESTHESIA Unique A means to an end Objective is usually intubation of the trachea.

4. RARELY Visualizing the upper airway & movement of the vocal cords Removing a foreign body Placing a R.T. or TEE Probe

5. TODAY’SPRESENTATION Techniques, devices & manouvres currently available to do a successful laryngoscopic intubation.

7. THE VARIABLES INVOLVED IN A SUCCESSFUL LARYNGOSCOPY The laryngoscope The airway anatomy of the patient Neonate, child or adult. Head, neck, body position Movement of cervical spine Mouth opening External laryngeal pressure View of the glottic aperture Placement of the endotracheal tube Appropriate analgesia / Anesthesia Expertise of the anesthesiologist.

8. LARYNGOSCOPES Direct Rigid laryngoscopes Indirect Rigid laryngoscopes which use fibreoptics, mirrors, prisms, etc. Video laryngoscopes – Rigid, Flexible Optical stylets Flexible fibreoptic endoscopes

9. DIRECT LARYNGOSCOPES • Dominant modality since 1940’s • Advantages – quick to use economical , rugged universally available • Disadvantage – alignment of the visual , oral & pharyngeal axis is needed.

12. CURVED & STRAIGHT BLADE LARYNGOSCOPE

13. CORMACK & LEHANE SCORE Gr I Gr II Gr III Gr IV

14. INDIRECT RIGID FIBREOPTIC / OPTICAL LARYNGOSCOPES Airtraq Bullard Wuscope Upsherscope Truview

15. ADVANTAGES • Blade shape conforms better to airway anatomy. • Lesser mouth opening and neck extension needed. • Alignment of oro-pharyngeal axis not necessary. • Easy to learn.

16. DISADVANTAGES • Costly. • Secretions and blood can impair the view. • Difference in angle of vision and glottic aperture. • Intubation may be difficult though view of glottis is good.

17. AIRTRAQ

18. AIRTRAQ

19. BULLARD LARYNGOSCOPE

20. WUSCOPE

21. UPSHERSCOPE

22. VIDEO LARYNGOSCOPES Glidescopevideolaryngoscopes Glidescope Cobalt Glidescope Ranger Angulated video intubation laryngoscope McGrath video laryngoscope Pentex airway scope Airtraq optical laryngoscope with video

23. ADVANTAGES • Magnified view with a wider angle. • The operator and assistant can see the same view and coordinate better. • Lesser mouth opening and neck extension needed. • Easy to learn and useful for teaching.

24. GLIDESCOPES Glidescope Ranger Glidescope cobalt

25. GLIDESCOPE COBALT

26. ANGULATED VIDEO INTUBATION LARYNGOSCOPE

27. McGRATH VIDEO LARYNGOSCOPE

28. PENTAX AIRWAY SCOPE

29. PENTAX AIRWAY SCOPE IN USE

30. OPTICAL STYLETS Shikani optical stylet Bonfil endoscope

31. SHIKANI OPTICAL STYLET (SOS)

32. SHIKANI OPTICAL STYLET (SOS)

33. BONFIL OPTICAL STYLET

34. ADVANTAGES • Useful in routine and difficult intubations. • Uncomplicated tools. • Easily learned. • Portable. • Simple to prepare.

35. DISADVANTAGES • Short optical depth . • Potential for impaired visualization due to fogging or secretions

36. FIBREOPTIC ENDOSCOPE

37. ADVANTAGES Laryngoscopic intubation can be done via nasal route also. Neck extension and mouth opening not necessary. Anatomical variations can be overcome. Topical / regional anaesthesia is adequate in the awake patient. Good view of the glottis, larynx, trachea and bronchi .

38. DISADVANTAGES • It is a delicate instrument and needs care. • High cost. • Takes a little time and practice to learn. • Tissue oedema and blood can obscure vision. • Cleaning / sterilization takes time.

39. SET UP

40. FOB AIDED INTUBATION UNDER LOCAL IN A PATIENT WITH CERVICAL FRACTURES

49. FOB UNDER TOPICAL & TRANSTRACHEAL INSTILLATION