Comparison of the Bullard and Macintosh Laryngoscopes for Endotracheal Intubation of Patients with a Potential Cervical Spine Injury 

Abstract

Cervical spine extension and time to intubation are similar for the Macintosh laryngoscope with ILS and the Bullard laryngoscope without ILS. However, time to intubation is significantly prolonged when the Bullard laryngoscope is used in a simulated emergency with cervical spine precautions taken. This suggests that the Bullard laryngoscope may be a useful adjunct to intubation of patients with potential cervical spine injury when time to intubation is not critical.

Tracheal intubation and cervical spine excursion: direct laryngoscopy vs. intubating laryngeal mask

“…Watts et al [12] showed in their study that the extension of the occipito-atlantoaxial complex was reduced when using the Bullard laryngoscope and in-line stabilisation compared with Figure 5 Change in angles C 2/3 before (1), during (2) and after (3) intubation, according to mean (SD). intubation via the Macintosh laryngoscope.…”

“…However, Mlinek et al [3] reported a mean duration of fibreoptic intubation in the emergency situation of 3 (2.2) min with the above mentioned risk of aspiration due to the prolonged intubating procedure and, in the only sedated patient, the hazard of neurological damage from defensive cervical spine movement. Watts et al [12] compared the Bullard and Macintosh laryngoscopes with or without in-line stabilisation for tracheal intubation of patients with a potential cervical spine injury. In the simulated emergency situation, they reported an intubation time of 25.6 (10.4) s using the Bullard laryngoscope without in-line stabilisation vs. 40.3 (19.6) s with in-line stabilisation and 20.3 (12.8) s for the Macintosh laryngoscope.…”

Direct and Indirect Laryngoscopy: Equipment and TechniquesDiscussion

“…Flange height and shape may vary significantly with blade choice (from flat, to slightly curved, to a completely closed tube in some straight blade designs). line stabilization, 46,47 in patients with suspected cervical spine injuries, 48 in routine airway management, 49 in anticipated difficult laryngoscopy, 50 and in unexpected difficult intubations. 51 It has been demonstrated in immobilized cervical spine simulators using naïve operators to be an easily mastered airway management device based on success, time, and ease of intubation.…”

Video-enhanced visualization of the larynx and intubation with the Bullard laryngoscope — equipment report

“…[7][8][9][10][11][12] As with fibreoptic bronchoscopes, a standard video endoscopy camera can be attached to the eyepiece of the BL to give a picture from the blade tip to a bedside monitor. [13][14][15] Video transmission of the endoscopic view has been reported to facilitate demonstration, teaching and supervision of fibreoptic procedures and to improve learning curves in novices.…”