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Laryngoscopy : Time to broaden our horizon . Dr Renu Devaprasath DNB ( Anaesthesia ) Dept of Anaesthesia Jeyasekharan Hospital Nagercoil Kanyakumari District. LARYNGOSCOPY. A procedure wherein the larynx is visualized
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Laryngoscopy: Time to broaden our horizon. Dr RenuDevaprasath DNB (Anaesthesia)Dept of AnaesthesiaJeyasekharan HospitalNagercoilKanyakumari District
LARYNGOSCOPY A procedure wherein the larynx is visualized Performed for diagnostic, therapeutic & intubation purposes by various specialists.
LARYNGOSCOPY IN ANESTHESIA Unique A means to an end Objective is usually intubation of the trachea.
RARELY Visualizing the upper airway & movement of the vocal cords Removing a foreign body Placing a R.T. or TEE Probe
TODAY’SPRESENTATION Techniques, devices & manouvres currently available to do a successful laryngoscopic intubation.
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.
LARYNGOSCOPES Direct Rigid laryngoscopes Indirect Rigid laryngoscopes which use fibreoptics, mirrors, prisms, etc. Video laryngoscopes – Rigid, Flexible Optical stylets Flexible fibreoptic endoscopes
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.
CORMACK & LEHANE SCORE Gr I Gr II Gr III Gr IV
INDIRECT RIGID FIBREOPTIC / OPTICAL LARYNGOSCOPES Airtraq Bullard Wuscope Upsherscope Truview
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.
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.
VIDEO LARYNGOSCOPES Glidescopevideolaryngoscopes Glidescope Cobalt Glidescope Ranger Angulated video intubation laryngoscope McGrath video laryngoscope Pentex airway scope Airtraq optical laryngoscope with video
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.
GLIDESCOPES Glidescope Ranger Glidescope cobalt
OPTICAL STYLETS Shikani optical stylet Bonfil endoscope
ADVANTAGES • Useful in routine and difficult intubations. • Uncomplicated tools. • Easily learned. • Portable. • Simple to prepare.
DISADVANTAGES • Short optical depth . • Potential for impaired visualization due to fogging or secretions
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 .
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.
FOB AIDED INTUBATION UNDER LOCAL IN A PATIENT WITH CERVICAL FRACTURES