EVALUATION OF THE BULLARD LARYNGOSCOPE USING THE NEW INTUBATING STYLET - COMPARISON WITH CONVENTIONAL LARYNGOSCOPY

The Bullard laryngoscope (BL) is a new device for managing the difficult airway. Previous publications on the BL are primarily descriptive, and fail to use internal controls (i.e., determine the best intubating mechanism) or external controls (i.e., compare the BL to a known standard such as conventional laryngoscopy). Therefore, we attempted to determine the best of four intubating mechanisms described for the BL (independently styletted endotracheal tube [ETT], the Bullard intubating forceps, an ETT with a directional tip or the new dedicated intubating stylet) and to determine whether time to successful intubation with the BL using the best intubating mechanism correlates with conventional grade of laryngoscopic view. The new intubating stylet provided the optimal intubating method; fewer attempts were required (1.1 vs 1.7, P = 0.005), and it took less time to successful tracheal intubation (39 +/- 34 s vs 83 +/- 74 s, P = 0.004) compared to the three other intubating mechanisms. Our results also suggest that the time to successful intubation with the BL using the intubating stylet was not affected by the conventional laryngoscopic grade; it was just as easy (and difficult) to intubate a conventional Grade I laryngoscopic view patient (full glottic view) as it was to intubate a conventional Grade III laryngoscopic view patient (visualization of just the epiglottis) with the BL. There were two failed intubations with the BL (3%) due to an inability to trap the epiglottis. Based on these results, and the fact that it is not essential to align the oral, pharyngeal, and laryngeal axes to view the glottic opening with the BL, the BL may be uniquely useful in trauma patients with uncleared cervical spines and in other patients when the head and neck cannot be manipulated.