A NEW LARYNGOSCOPE FOR INFANTS AND CHILDREN

1034 above the other, which can be inflated with oxygen or compressed air. The multitubular side construction is adopted to obtain the required height without making the walls too wide, and to allow them to collapse completely when deflated. The tubes are connected to one outlet, and deflation may be assisted by connecting it to the operating-theatre suction system. A large outlet port has been formed in the base to allow emptying of the water. The tank is made of antistatic rubberised fabric, and all seams and joints are covered with bias tape. In use, the tank is easily lifted on to the table, and secured with the straps provided. The patient is anaesthetised in the anaesthetic room, and then lifted on to the deflated tank on the operating-table, where endotracheal intubation is performed, the thermocouples and electrocardiograph leads are attached, and the intravenous infusion is set up. When he is ready for cooling, the sides of the tank are inflated, and cold water is run in. Top straps are provided to prevent the sides from bowing outwards. Ice is then added to the water, and to simplify paddling of the iced water round the patient the height of the table may be adjusted. When the patient’s temperature is sufficiently depressed, or should there be cardiac arrest, the water is run out and the sides are deflated to allow the operation one

to

begin. rewarming

water is circulated through the base mattress in the usual way. At the conclusion of the operation the sides are again inflated, and the tank is filled with warm

The

water.

has a curved tip, and which is used in the same way as the Macintosh blade. Its C-section, however, though valuable in cleft-palate work, is a disadvantage for normal patients.

The New Infant Laryngoscope (Mark 1)) About ten years ago, after trying the Soper baby blade,3 I had made a similar blade, but with a slightly curved tip rolled

Fig. 1-The mark-1 infant laryngoscope blade.

the end (fig. 1). A few of these blades only were supplied special order, but they have been in constant use ever since. They have proved satisfactory for neonates, including premature babies, and for children up to about five years old, in a unit where very nearly all the patients are intubated for thoracic or ear, nose, and throat operations. They have also found a place at

to

in the resuscitation of the newborn. Laryngoscope with Binocular Vision (Mark 2) The original mark-1 blades were made of brass and were chromium-plated. To make them more suitable for production

We wish to thank the North West Metropolitan Regional Hospital the tank; Dr. Brian Sellick Board for a grant to enable us to for his advice; and the Dunlop Rubber Co., who produced the tank for us. The mattress is supplied by Capon Heaton Ltd., and the tank may be obtained from the Dunlop Rubber Co., which will also have press-studs fixed to the mattress so that it may be secured to the base of the tank.

develop

MICHAEL ESSEX-LOPRESTI M.R.C.S.,

D.A.

Assistant Senior Medical Officer

North-West Metropolitan

Regional Hospital Board, London, W.2

KENNETH EATWELL M.I.MECH.E.,

M.I.H.V.E.

Lately Deputy Regional Engineer*

A NEW LARYNGOSCOPE

FOR INFANTS AND CHILDREN THE usual method of laryngoscopy involves lifting the epiglottis with the tip of the laryngoscope. In adults this is not difficult when the patient is relaxed. But in small babies the epiglottis is short, U-shaped in section, and relatively higher in the pharynx. It also projects further backwards into the pharynx than in an adult, making it more difficult to pick up. Its smallness may cause it to slip off the tip of the instrument two or three times before intubation can be accomplished, thus increasing the possibility of trauma. Nearly twenty years ago Sir Robert Macintosh1 described a new laryngoscope designed to lessen the difficulty of exposing the larynx. It was based on the now well-known principle of lifting the base of the tongue and with it the attached epiglottis, rather than picking up the epiglottis itself. This method has much to commend it in infants, and the open-type blade of Z-section which Macintosh introduced has many advantages (except in cleft-lip cases) in allowing more room in the mouth for suction catheters or for intubation. It can be made slimmer and therefore easier to introduce. The Macintosh blade for adults can be used even in the newborn, though it is a little clumsy. The smaller blades, introduced for children and babies, however, were much too curved. They were virtually superseded by the Oxford infant blade,2 which is straight but *

1. 2.

Now

Regional Engineer to the South West Metropolitan Regional Hospital Board. Macintosh, R. R. Lancet, 1943, i, 205. Bryce-Smith, R. Brit. med. J. 1952, i, 217.

Fig. 2-The

new

blade in stainless steel.

This section allows

binocular vision.

in stainless steel, the Longworth Company recently, suggested a revised section for the blade (fig. 2). This retains all the essential features of the original form, and in addition it has unexpected advantages. The new section, by removing the lateral wall of the instrument, enables the left eye, as well as the right, to see the glottis. The resulting binocular vision allows better judgment of depth; and intubation or pharyngeal toilet with a sucker can be performed with less trauma. Trauma to the gums or teeth of the upper jaw is also less likely, because the new model is more rounded, and there is no sharp edge to lacerate the gums if the blade should accidentally slip sideways. These blades will fit the standard Longworth handle, but they are best used with the small (bronchoscope) handle. I am grateful for the friendly and enthusiastic cooperation of Mr. J. A. Jephcott and his colleagues, of the Longworth Scientific Instrument Co., which is making these blades. Park Hospital,

FRANK L. ROBERTSHAW

Davyhulme,

M.B.

Manchester 3.

Soper, R.

St.And., F.F.A. R.C.S.,

L. ibid. 1947,

i, 265.

D.R.C.O.G.