Assessment of an angulated laryngoscope for difficult paediatric intubation

Abstract

SummaryAngulated laryngoscopes with mirrors and prisms have been previously described for difficult tracheal intubation in adults, but not in children. We assessed the use of a recently described adult angulated laryngoscope (BelscopeTM) with or without prism, for difficult tracheal intubation in children. We use this laryngoscope as part of our difficult tracheal intubation regime before proceeding to other methods such as fibreoptic tracheal intubation. Children included were anticipated to be a difficult tracheal intubation from physical examination or previously had been difficult to intubate. Laryngoscopy was initially performed with a straight (Miller) or curved (Macintosh) laryngoscope. This was then repeated using the angulated laryngoscope, with prism if necessary. Degree of visualization of the larynx was scored with both methods. There was improvement in visualization in children with micrognathia, prominent maxillae or with an apparent ‘anterior larynx'. In children where there was no improvement, this laryngoscope did not actually cause a deterioration in grade of laryngoscopy.