Intubation Problems

Sir,

Difficult intubation still remains a nightmare for the practicing

Expensive and costly devices were introduced to the field to overcome

I have joined two devices together with a little bit of modification that

may improve the chances of successful intubation at a very low cost.

A Patil - Syracuse Adjustable Laryngoscope handle is used,

with this handle the blade can be locked in four different positions,

180, 135, 90, (standard), or 45 degrees (Howland lock angle).

In the 180 degrees position the blade can be introduced parallel to the

handle when extension of the neck is contraindicated because of cervical

spine fractures or instability. Visualization of the larynx is also

facilitated in obese patients or those on halo traction.

In the 45 degree position, all advantages of the Howland lock are

The handle accepts two AA batteries and fits all hook-on type

laryngoscope blades. The overall length and weight of the handle is

approximately the same as that of conventional handle.

At my workshop, I modified the tip of four different sizes ( 1 -4 ) Macintosh blades.

The tips of the blades were curved inwards at an angle of 30 degrees at the last 1.5 - 2.5 cm. of the blade. This modification will add all the advantages the McCoy blade offers.

The handle and the modified blades were used together for difficult

Thirty five medical students and doctors were asked to try this system

versus the conventional one in an intubation module at our

cardiopulmonary (CPR) center. They all confirmed that they have better view and easy intubation with the modified blade and laryngoscope.

I have successfully intubated 15 patients, labeled as difficult

intubation, grade 3 and 4, by using the modified Macintosh

blades and the adjustable handle. Conventional handles were also used with success in cases where adjustable handles were not indicated. However a larger and more scientifically designed study is required to confirm the efficiency of this product.

I think this simple modification will help solving the problem of

difficult intubation in most of the cases, in all ages, and at a very

low cost, compared to other expensive laryngoscopes, recommended at

The handle cost only $80 and any set of old blades can be modified and

kept a side ready for use in case of difficult intubation. I think the idea does work for all difficult intubation in patients who can open their mouths at a very low cost.

The whole set of my device will cost $80 if old blades were used.

New blades will add an extra cost of $30 per blade.

At this price , this device will be 80% cheaper than most of the

available device used for difficult intubation now.

I think this idea can help reduce mortality and morbidity due to failed

intubation, particularly in departments running at low budgets and

My colleagues how found this device very useful and helpful in their

Dr. Magboul M. A. Magboul, M B; B.S., F. F. A. R. C.S. I