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INTRODUCTION

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Intubation devices are a critical component of administering general anesthesia. By facilitating endotracheal intubation, these devices secure the patient’s airway, thereby protecting the patient from aspiration, laryngospasm, and anatomic obstruction.

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RIGID LARYNGOSCOPES

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The rigid laryngoscope is essentially a retractor-type device. This laryngoscope elevates the tongue and other soft tissues within the pharynx to create a straight line of vision, or “line of sight,” between the operator’s eye and the larynx. Multiple devices are available that differ in the location of the light source, dimension of the hinges, and shapes of the blades and handles.

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  1. The Miller blade is inserted posterior to the epiglottis and is ideal for children or adults with a large epiglottis that obstructs the view of the vocal cords. Proper placement of the Miller blade will stimulate the vagus nerve (CN X). It is available in sizes 00, 0, 1, 1.5, 2, 3, and 4.

  2. The Macintosh blade is the most common blade used in adults in the United States. It is inserted into the vallecula from the right side of the oropharynx and advanced midline manipulating the tongue to the left. Once in position, the handle is lifted up and outward to elevate the larynx and expose the vocal cords. Proper placement of the Macintosh blade will stimulate the glossopharyngeal nerve (CN IX). It is available in sizes 0, 1, 2, 3, 3.5, and 4.

  3. A left-handed Macintosh blade is available. It is a mirror image of the standard Macintosh blade, containing a right-sided groove for directing the tongue rightward as it is advanced midline. It is intended for use by left-handed practitioners or for use on patients with atypical anatomy on the right side of their face. The blade is only available in size 3.

  4. The McCoy blade is similar to the Macintosh blade but includes an additional hinge with handle to maneuver an adjustable tip at the distal portion of the blade. It is designed to elevate the vallecula and epiglottis when the adjustable tip is flexed.

  5. The Soper blade is a straight blade with a left-sided groove and is used predominantly for intubating neonates and infants. The flat portion of the blade is used to restrict tongue motion.

  6. The Wisconsin blade is a straight blade with a semicircular groove to allow passage of the endotracheal tube through the circular portion after establishing a view of the larynx.

  7. The Robertshaw blade is a curved blade that is rounded at the distal third portion. Similar to the Macintosh blade, it is designed to lift the epiglottis. The benefit of this blade is greatest when facilitating nasotracheal intubation because it provides a superior view of the pharynx compared to the Macintosh blade, particularly after the Magill forceps have been introduced.

  8. The Seward blade is a straight blade with a curved distal tip. It is predominantly used for assisting nasotracheal intubation in children younger than 5 years of age ...

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