USE OF THE BULLARD LARYNGOSCOPE AND LIGHTWAND IN PEDIATRIC PATIENTS

Abstract

Many different devices have been designed to simplify management of the “difficult airway.” An important fundamental difference that needs to be clarified is that between “difficult airway” management and the “difficult intubation.” The difficult airway refers to problems in maintaining oxygenation or ventilation and implies an urgent need to establish an airway by whatever means necessary. Difficult intubation refers specifically to ease of performing direct laryngoscopy and endotracheal intubation using “standard” instruments. Many devices have been invented to deal with difficult intubation in adults. The Bullard laryngoscope and lightwand are specifically designed to simplify the difficult intubation. This article reviews specially designed pediatric versions of these devices. Conventional direct laryngoscopy requires the alignment of three axes in the airway: oral, pharyngeal, and laryngeal. Normally, this is easily accomplished by using the “sniffing” position; however, in children with anatomic abnormalities, sniffing may not be advisable or aid laryngeal visualization. Both the Bullard laryngoscope and lightwand make repositioning the neck for intubation unnecessary. This article explores the indications, contraindications, and ways to use these devices in the management of the difficult pediatric intubation. Their appropriateness for use in the management of the difficult airway is also considered.