Suction Laryngoscope

Abstract

To the Editor: We wish to report our experience, in a Level 1 trauma center, with a custom-designed laryngoscope blade that permits continuous suctioning of pharyngeal secretions during all phases of direct laryngoscopy. A number 2 Miller laryngoscope blade was modified so as to incorporate a rigid channel to facilitate the insertion of a standard 10 French tracheal suction catheter down the long axis of the blade from handle to tip. Requirement for prompt endotracheal intubation becomes critical when there is potential for pulmonary aspiration in a patient presenting with retropharyngeal or gastrointestinal bleeding, with copious oral secretions, or with frank emesis. These are circumstances in which maintaining a clear view of the laryngeal structures during the time taken for exchange of suction tip for endotracheal tube can become alarmingly difficult--situations that seem to occur more often in an emergency room or hospital ward setting than in the more controlled environment of the operating room. With our simple modification Figure 1, it has proven possible for a single operator to maintain continuous suction of fluid secretions at the tracheal orifice, coincident with endotracheal intubation, while constantly watching the vocal cords; our device eliminates the need to reach blindly for a suction catheter or endotracheal tube. If necessary, the catheter can be advanced distal to the vocal cords to effect direct aspiration of tracheal contaminants. We have found no increased difficulty in direct laryngoscopy because of the presence of the suction catheter guide, and the use of disposable catheters ensures acceptable sanitary standards. We believe that a similar modification can be made to laryngoscope blades of smaller caliber, permitting effective suctioning of meconium, without repetitive intubation, during resuscitation of newborns at risk for aspiration.Figure 1: Suction laryngoscope.Monica Vavilala, MD John Bramhall, PhD, MD Department of Anesthesiology University of Washington School of Medicine Harborview Medical Center Seattle, WA 98104