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Using a Left-Handed Laryngoscope Blade
- Kim Russon, Tony Thomas, Royal Hallamshire Hospital, Sheffield (5 February 2007)
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Optimal usages of the left hand laryngoscope blade need to be explored
- Sanjib Das Adhikary, T.Venkatesan, M.Ponniah (5 February 2007)
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Left-handed laryngoscope blade in difficult airway
- Siby Sebastian (22 January 2007)
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Kim Russon , Tony Thomas, Royal Hallamshire Hospital, Sheffield
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Dear Editor, We read the article by Dr Das Adhikary et al(1) with interest. Within our practice we have also found the left-handed laryngoscope blade an invaluable tool for patients with right sided facial pathology such as tumour, infection, deformity from contractures or skin flaps post surgery or post radiotherapy. We have a series of patients who have been previously intubated awake due to anticipated difficulty but were an easy intubation with a left-handed laryngoscope blade. We must stress the importance of achieving familiarity with the left- handed blade prior to using it in a potentially difficult airway. Even for experienced anaesthetists holding a laryngoscope in your right hand feels awkward and unnatural, similarly intubating with your left hand. In our establishment trainees are encouraged to practice with the left-handed laryngoscope blade on easy elective patients and so should anyone considering using it for an anticipated difficult airway. References 1 Das Adhikary S, Venkatesan T, Mohaanty S et al. Difficult laryngoscopy made easy with the use of left-hand laryngoscope blade. Br J Anaesth 2007;98:141-4 Conflict of Interest:None declared |
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Sanjib Das Adhikary, Consultant Anaesthetist Department of Anaesthesia, Christian Medical Collge, Vellore, Tamil Nadu, India, T.Venkatesan, M.Ponniah
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Dear Sir, We thank Dr. Siby Sebastian for showing interest in our article on left hand laryngoscope blade [1]. We strongly agree with his views that the use of left hand laryngoscope blade is not limited to only securing airway for lesions located on the right side of the upper airway [1]. It can be effectively used whenever the endotracheal tube mandates a fixation on the right side of the mouth. We would like to share another clinical scenario where this blade was helpful in visualizing the larynx of an infant who presented for a cleft lip repair. The presence of a cleft on the left side of the lip had led to hypertrophy of the right maxilla as well as the portion of the lip on the right side (Fig.1). Visualization of the larynx was not possible when attempted with the right sided size 2 Macintosch blade. The use of a similar left handed blade made things simple. With these few available reports we suggest that it has a definite role in the management of difficult airways in specific scenarios in different age groups. However, it is presumed that the successful usage of the blade needs prior practice, which may not be true always. A randomized crossover trial comparing the conventional blade with the left hand laryngoscope blade in various clinical scenarios if attempted, can explore the optimal usages of this blade. Reference: 1. S. Das Adhikary, T. Venkatesan, S. Mohanty, and M. Ponniah Difficult laryngoscopy made easy with the use of left-hand laryngoscope blade Br. J. Anaesth. 2007; 98: 141-144 Figure: 1 Infant with a cleft lip on the left side leading to hypertrophy of the maxilla and the portion of lip on the right side. Conflict of Interest:None declared |
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Siby Sebastian, Anaesthetist Manor Hospital, Walsall, UK
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Editor - I read with great interest the case reports presented by S Das Adhikari and colleagues. I am reporting a similar case we recently had in our ENT theatre. A 46 year old caucasian man was scheduled for elective nasal polypectomy. He had previous general anaesthesia without any problems. So we decided to proceed with general anaesthesia and neuromuscular blockade. But his larynx was not visualised with a standard macintosh no. 4 laryngoscope. The blade was not engaging the epiglottic vallecula, apparently due to a swelling on the right side of his epiglottis. Laryngoscopy was abandoned and he was oxygenated with a laryngeal mask airway. A left-handed laryngoscope blade was obtained in the mean time with which the vocal cords were visualised and trachea was intubated over a bougie using portex 8.0 tube. This incidence signifies the importance of left-handed laryngoscope blade in a difficult airway situation. It is also useful in placing tracheal tube on the left side of mouth as pointed out by R W Buckland [1]. Reference: 1. R. W Buckland. The left-handed laryngoscope. Anaesthesia. 1999 Jun;54(6):602-3 Conflict of Interest:None declared |
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