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 difficu lt 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 stan dard such as conventional laryngoscopy). Therefore, we attempted to de termine the best of four intubating mechanisms described for the BL (i ndependently styletted endotracheal tube [ETT], the Bullard intubating forceps, an ETT with a directional tip or the new dedicated intubatin g stylet) and to determine whether time to successful intubation with the BL using the best intubating mechanism correlates with conventiona l 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 intub ating mechanisms. Our results also suggest that the time to successful intubation with the BL using the intubating stylet was not affected b y the conventional laryngoscopic grade; it was just as easy (and diffi cult) to intubate a conventional Grade I laryngoscopic view patient (f ull glottic view) as it was to intubate a conventional Grade III laryn goscopic view patient (visualization of just the epiglottis) with the BL. There were two failed intubations with the BL (3%) due to an inabi lity 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 usefu l in trauma patients with uncleared cervical spines and in other patie nts when the head and neck cannot be manipulated.