The adult Bullard laryngoscope as an alternative to the Wis-Hipple 1 1/2 in paediatric patients

This prospective, randomized study was undertaken to compare the adult Bull ard laryngoscope (BL) with the Wis-Hipple laryngoscope (WhL) in paediatric patients with regards to laryngeal view and time to intubation, and whether its efficacy was related to age or weight. Fifty patients scheduled for ge neral anaesthesia between the ages of 1 and 5 years were examined. Patients were randomized into two groups: one group had an initial laryngoscopy via the WhL and then had a laryngoscopy and intubation using the BL; the secon d group had an initial laryngoscopy with the BL and then had a laryngoscopy and intubation using the WhL. The laryngeal view, attempts at intubation, time to intubation and the reason for any difficulty with intubation were r ecorded. Correlation was then sought relating attempts and time to intubati on with age, and weight. Mean time to intubation was 20 +/- 6s in the WhL g roup and 26 +/- 9 s in the BL group (P < 0.02). The majority of the patient s had similar laryngeal views in both groups; three patients had a superior view with the BL. Failed intubations occurred in two BL patients; the trac heas were both intubated with the WhL. In one patient, intubation was not p ossible with the WhL but it was successful with the BL. Multiple passes of the tube off the BL most frequently occurred because of right aryepiglottic fold contact or anterior vocal cord contact. The latter appears to be more problematic when the adult BL is used in the paediatric population. No rel ationship was found between the time to intubation and age or weight. Ln an occasional child, the BL provides a superior laryngeal view and provides a means for a successful intubation when a failure with the WhL occurs. Alth ough intubation of children aged 1-5 years takes longer with a BL than a Wh L, the adult BL complemented the WhL laryngoscope in paediatric patients.