Laryngoscope design and the difficult adult tracheal intubation

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Abstract
Clinical examination of a patient is very likely to reveal the factors making tracheal intubation difficult and thus increasing the likelihood of a traumatized temporo-mandibular joint or mouth. Although laryngoscopes and bronchoscopes incorporating fiberoptic visual devices are invaluable they are usually only employed for extremely difficult patients. Other laryngoscopes exist in a variety of designs and can be categorised according to the particular problem they address: (i) prominent sternal region, (ii) narrow space between the incisors, (iii) reduced intraoral space and, (iv) the anteriorly positioned larynx. An atraumatic tracheal intubation will be assisted if the laryngoscope blade to be used is selected on the basis of the anatomic difficulties prescribed by the patient. The Miller, Jackson-Wisconsin, Macintosh, Soper, Bizarri-Guffrida, and Bainton blades together with appropriate handles and fittings comprise a group from which selection can be made. Lors de ľexamen physique ďun patient, on peut habituellement prédire si ľintubation trachéale risque ďêtre difficile et susceptible ďendommager bouche et articulation temporomandibulaire. Pourtant, on a tendance à réserver ľusage des laryngoscopes et bronchoscopes à fibres optiques flexibles aux cas les plus complexes. On peut classifier les autres types de laryngoscope en fonction des particularités anatomiques qu’ils permettent de contourner: sternum proéminent, espace resteint entre les incisives, petit volume de la cavité orale, larynx dit antérieur. En choisissant parmi les Miller, Jackson-Wisconsin, Macintosh, Soper, Bizarri-Guffrida et Bainton, les lames et manches de larygoscope appropriés à la morphologie du patient, on pourra plus facilement intuber la trachée en douceur.