Bullard Extender Use with the Bullard Laryngoscope

Abstract

To the Editor: We noted the clinical communication from Habibi et al. [1] regarding the difficulty they experienced with the plastic blade extender for the Bullard[trade mark sign] Intubating Laryngoscope (Circon Corporation, Stamford, CT). We began using the Bullard[trade mark sign] scope in our level 1 trauma center academic emergency department (ED) approximately 1 yr ago. In our ED, the Bullard[trade mark sign] is used by third- and fourth-year emergency medicine residents and attending physicians to intubate adult patients. Early on, there were two unsuccessful intubation attempts attributed to inadequate blade length (the glottis was not visualized due to inability to elevate the epiglottis). Subsequently, we instituted a policy that the plastic blade extenders be used in every Bullard[trade mark sign] laryngoscopy. Our experience with the Bullard[trade mark sign] scope consists of >70 nonconsecutive ED intubations under a variety of challenging and difficult conditions, including patients with a severely limited mouth opening due to facial trauma and the presence of hard cervical collars. The blade extender is always pre-loaded onto the scope, and its security is checked by the oncoming resuscitation room resident at the beginning of each shift. Although the extender has never been dislodged during laryngoscopy or intubation, its presence is always confirmed at the end of the procedure. Removal of the extender requires significant and deliberate force, even when using the manufacturer-provided tool specifically designed for removal. It seems unlikely that a properly loaded blade extender could be inadvertently lost in the patient's airway, even when traversing the teeth through a limited aperture. We echo Habibi et al.'s [1] admonition to install the blade extender carefully and securely and to confirm its position after the Bullard[trade mark sign] scope is removed from the patient's airway and mouth. However, in our experience, it is unlikely that when properly installed, it could possibly be dislodged before deliberate removal. Charles V. Pollack, Jr., MA, MD Paula Wadbrook, MD Department of Emergency Medicine; Maricopa Medical Center; Phoenix, AZ 85008