An analysis of laryngoscope blade shape and design: new criteria for laryngoscope evaluation

Laryngoscope blade design has tended to be relatively arbitrary and so far scientific analysis has not allowed useful comparisons between blade shapes. A new theoretical method of analysing laryngoscope blades is introduced and uses the depth of insertion profiles of two angular measurements. One represents eyeline displacement and the other the forward space that the blade occupies at the level of the mandible. Photographs of straight and curved blades were studied on Cartesian graphs with the tip T, at the origin and handle fittings parallel to the x-axis of the graph. Then, IT is any line from the origin to the incisor surface and represents a point of contact with the upper incisors for a given depth of blade insertion. Angle EIT (eyeline displacement) is to a tangent from I along the lower lingual surface of the blade. Point M is on the upper lingual surface of the blade, at right angles to IT, 1/3 of the distance from I along IT. Angle MIT (forward space) may be positive or negative depending on whether M is in front of or behind IT. The angles EIT, MIT and their additive combination are used in blade analysis. Negative MIT compensates for eyeline displacement as Macintosh size 3 and 4 blades have better combination scores than Miller size 3. All three are superior to the straight Soper size 3 blade. The Macintosh size 1 and 2 blades are quite different from the larger Macintosh blades. This theoretical basis for blade analysis is consistent with commonly expressed clinical opinions and may influence blade design in the future.