TREATISE ON PLASTIC LARYNGOSCOPES, VOLUME 1

Back when I was a GP, I did some locums in an incredibly remote place where the total population was pretty much me and a nurse. Between the delirious bouts of cabin fever, I would sometimes, rarely, muster the energy to actually practice something that one day might be useful.  So one day I asked for the intubation kit. The kind nurse procured a dirty old plastic bag containing some dusty size 9 tubes, a McGill’s forceps and a plastic laryngoscope

A plastic laryngoscope is an abomination. They look wrong, feel wrong and are just plain wrong in so many ways. No surprise then, how several studies demonstrate how they are inferior to stainless steel laryngoscopes. Here’s one. Published in Am J Emerg Med 2011 vol 29. According to this study, first-pass-success is 10% better with stainless steel blades than plastic ones.

The study has weaknesses, and perhaps all it proves is how paramedics don’t like plastic laryngoscopes. But then again, who does?


Am J Emerg Med. 2011 Jul;29(6):590-3. Epub 2010 Apr 2. Disposable stainless steel vs plastic laryngoscope blades among paramedics. Dos Santos FD, Schnakofsky R, Cascio A, Liu J, Merlin MA.

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7 Responses to TREATISE ON PLASTIC LARYNGOSCOPES, VOLUME 1

  1. Minh Le Cong says:

    Metal blades and laryngoscopes are not perfect either..check out this case!

    http://www.anaesthesiacases.com.au/cases/bad_day_at_the_office

    • Thomas D says:

      Yeah, I read that piece! Talk about bad day at the office! But were those metal blades? I always pictured them as plastic blades on metal laryngoscope handles?

      But I agree, full metal laryngoscopes have their problems as well. One such thing is when the connection between the handle and blade gets worn. I used to check my laryngoscope by just opening it to see the light was working and bright. Then I had an emergency caesarean section in GA, big lady, where I had to lift really hard on the laryngoscope to get a view. Every time I did that, just as I was seeing the vocal cords, it went dark. Changed blade. Same thing. Changed to a different laryngoscope. This time everything worked. I got the tube in, saw the capnography trace and then the saturation coming back up from the 80s and got my pulse back down.

      Some of these worn all metal laryngoscope handles/blades lose the connection under pressure. Now I always pull hard on the open laryngoscope blade when testing before starting the anaesthesia.

  2. Gavin Doolan says:

    These disposable metal blades are also horrible. They flex as soon as you put any force on them.

    http://www.alibaba.com/product-free/104399566/single_use_laryngoscope_blade/showimage.html

    • Thomas D says:

      Yeah, I’ve tried those. Didn’t like them. It feels like the plastic on the hinge makes them weird. Like you said, you can feel the flex.
      BTW, I like your Anaestricks page. Great little tricks of the trade. Thanks for sharing!

  3. I ‘m with Gavin (not in bromance kind of way, let’s be clear) – those metal-bladed disposable laryngoscopes are the worst – you can bend the blade with enough force and I’ve had the batteries ‘ping’ put in the middle of an RSI cos the screw-lid bottom wasn’t adequately secured

    For me, it’s good ol’ fashioned metal blade first up – then my plastic bladed but oh-so-gorgeous KingVision VL as a back up – yes, it’s a different technique to std Mac blade, but the midline approach to vallecula means very little force needed – just line up the cords and use the channelled blade to ‘pot’ the tube.

    I can empathise with your experiences of rural GP – first time I asked for a chest tube I was given a urinary catheter – we’ve since done a LOT of upskilling and equipment resourcing. But sadly the airway equipment available to many rural docs is antiquated – an audit of my local institution revealed that the volunteer ambulance officers had more kit available to them than the hospital’s airway trolley…

    Scary.

  4. Minh Le Cong says:

    I have tested the Israeli made Trulite disposable laryngoscope.steel blade with LED light, plastic handle. No flex in blade and decent light . fully disposable in all sizes, Mac and Miller style. Its a decent laryngoscope for twelve dollars AU.

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