We thank Dr Mackenzie for his letter raising a number of issues which we are grateful for the opportunity to respond to. The system referred to by the author is the Callisto ‘No-Touch’. This system is specifically designed so that the tip of the blade is prevented from touching the barrel of the laryngoscope handle. This is to prevent possible episodes of cross-contamination whereby a clean blade can be contaminated, prior to insertion, from the barrel of a reusable handle against which the tip of a used blade may have rested [1]. The correct position prior to the blade being fully locked onto the handle is well shown in Fig. 2a of Dr Mackenzie’s letter. Figure 2b however, shows a ‘non-recommended’ position for the Callisto ‘No-Touch’. In our instructions for use leaflet, which accompanies all of our single-use laryngoscope blades, we state that, prior to use on the patient, the laryngoscope blade is correctly fitted to the handle and a check is made to ensure that the light is functioning. We also advise that spare blades and handles are available in case of failure and we note that this was carried out in the case described. We try to make it as clear as possible within our instructions for use, in both the line drawings and accompanying text that prior to actual use. Pressure is applied to the heel of the blade until it ‘clicks’ into position onto the bar. Immediately thereafter, the tip of the blade is lifted such that it ‘locks’ into a normal operating position on the laryngoscope handle, rendering the blade and handle ready for use. In Fig. 2c, the laryngoscope is also in a ‘non-recommended’ position and we suggest that it was this error that led to the incident described. However, in light of the issues raised by Dr Mackenzie, we are undertaking a review of our Callisto instructions for use to examine whether there is any way in which they can be made clearer. With respect to the physical strength of the Callisto system blade/handle interface, we wish to point out that due to failures of early single-use blades from some manufacturers, this blade is designed such that the metal of the blade continues fully into the hook structure. This prevents any possibility of a blade detaching from a plastic hook moulding. Furthermore the system has been formally tested by The Rubber and Plastics Research Association in February 2008. Briefly, a fixture attached to a tensile test machine was produced which would grip the handle of the laryngoscope and measure any applied force. A second fixture was then designed to apply an upward vertical load to the centre of the blade, simulating its normal orientation during use. On a series of blades, a load of 30 N was applied and maintained for 5 min. During this time the interface between blade and handle was inspected for distortion or detachment, none being seen. At the end of this period, the load was increased until failure occurred. This occurred over a range of 303–327 N, representing an upward force equivalent of 31–33 kg which we believe should be a sufficient structural safety margin for most patients.
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