[The Bullard laryngoscope. An aid in unforseen difficult intubation]

The standard procedure when difficulties are anticipated with intubation, e.g. following the clinical classification as per Mallampati, is the fibreoptic bronchoscopic method applied while the patient is awake. In the case of unexpected difficulties encountered during intubation while the patient is anaesthetized, a scenario that cannot be absolutely ruled out, e.g. in an emergency resection when there is no longer a simple method of returning the patient to the waking condition, and when problems are accentuated by seriously hampered mask respiration, aspiration risk, danger of hypoxia, and visual obstruction by secretions and blood, the fibrebronchoscope is no longer the instrument of choice. A larynx mask or a combination tube is probably a better option. Our experience has shown that the Bullard laryngoscope (BL) can help to improve the situation because, while it has similar advantages to the flexible bronchoscope, it can be operated almost exactly as quickly as a Macintosh intubation spatula. In contrast to the bronchoscope, fibreoptic orientation under impeded visual conditions caused by secretions and blood is, in our experience, much easier. The BL is routinely deployed, as an alternative to the Macintosh instrument, for practice purposes by all our colleagues in the department. It has proved to be remarkably effective: to date it has led to the target quickly and without complications in every case. As examples three case histories selected from a series of cases in which the BL was used have been highlighted.