Light intensity of curved laryngoscope blades in Philadelphia emergency departments

Laryngoscopy and tracheal intubation requires laryngeal exposure and illumination. The objective of this study is to assess variation in laryngoscope lights across different emergency departments (EDs).

A convenience sample of 3 Mac #4 blade and handle pairs in each of 17 Philadelphia area EDs was tested with a digital light meter to derive the median lux at the distal tip. For each blade tested, we characterized blade design (American, English, or German) and light type (fiber-illuminated versus conventional bulb-on-blade) and measured light-to-tip distance.

A total of 50 blades and handle pairs were tested (one ED had only 2 Mac #4 blades). American designs were the most common (38/50), followed by English (6/50) and German (3/50) designs. Three blades had hybrid design features and acrylic light-conducting fibers. Median luminance varied from 11 lux to 5,627 lux. The glass fiber-illuminated blades (n=13) produced greater luminance (median 1,205 lux; interquartile range [IQR] 726 to 2,176 lux) than bulb-on-blade designs (median 689 lux; IQR 290 to 906 lux). German fiber-illuminated blades produced the highest luminance (median 1,937 lux; IQR 1,453 to 3,782 lux). English bulb-on-blade designs produced more luminance (median 915 lux; IQR 745 to 1270 lux) than American (median 689 lux; IQR 269 to 807 lux). German and English blades had shorter light-to-tip distances (median 51 mm and 47 mm, respectively) than American blades (65 mm).

Curved laryngoscope blades in different EDs have marked variation in light intensity. The contribution of luminance to laryngoscopy performance warrants investigation.