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The adult Bullard laryngoscope in paediatric patients
G B Shulman1, N R Connelly, C Gibson
1Department of Anesthesiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA.
Insights
The adult Bullard laryngoscope (BL) is effective for pediatric airway management. Its use in children aged 1-10 years showed no correlation with age, weight, or height.
Area of Science:
- Anesthesiology
- Pediatric Airway Management
Background:
- The adult Bullard laryngoscope (BL) is a recognized tool for adult airway management.
- Its applicability in pediatric patients has not been extensively studied.
Purpose of the Study:
- To evaluate the efficacy of the adult Bullard laryngoscope (BL) in pediatric patients.
- To determine if BL efficacy correlates with patient age, weight, or height.
Main Methods:
- A study involving 50 pediatric patients (ages 1-10 years) undergoing general anesthesia.
- Exclusion criteria included craniofacial abnormalities and need for rapid sequence intubation.
- Data collected included laryngeal view, intubation attempts, time, and difficulties encountered.
Main Results:
- Mean intubation time was 38 +/- 13 seconds.
- Difficulties included aryepiglottic and anterior vocal cord contact.
- No correlation found between intubation time and patient demographics (age, height, weight).
- Four patients under 38 months could not be intubated after four attempts.
Conclusions:
- The adult Bullard laryngoscope (BL) is a viable alternative for managing normal pediatric airways.
- Efficacy is independent of patient age, weight, or height in this cohort.
Purpose:
The adult Bullard laryngoscope (BL) is effective in managing both normal and abnormal airways. Although its name implies use in the adult population, its size does not preclude its use in paediatric patients. Thus we evaluated whether the adult BL could be used in the paediatric population and whether its efficacy was related to age, weight, or height.
Methods:
Fifty consecutive patients, between the ages of 1 and 10 years and scheduled for general anaesthesia, were examined. Exclusion criteria included obvious craniofacial abnormalities or indications for rapid sequence intubation. All patients had intravenous access secured before laryngoscopy. The laryngeal view, attempts at intubation, time to intubation and the reason for any difficulty with intubation were recorded. Correlation was then sought relating attempts and time to intubation with age, weight and height.
Results:
Mean time to intubation was 38 +/- 13 sec. Multiple attempts occurred most frequently because of right aryepiglottic fold contact or anterior vocal cord contact. The latter appears to be unique to the adult BL use in the paediatric population. No relationship was found between the time to intubation and age, height, or weight. Four tracheas, all in patients < 38 mo, could not be intubated with the BL after four attempts.
Conclusion:
The adult BL appears to be an effective alternative tool in the management of the normal paediatric airway.