Video and Optical Laryngoscopes

The Bullard Laryngoscope is the grandfather of all the look around the curve of the tongue intubation devices, dating back almost 30 years.  It uses fiberoptics combined with a tongue retractor. A new version of the device (now sold through Olympus) will have an integrated video system. Other devices combining fiberoptics with tongue retractors include the Wu-Scope and Upsher Scope. Although these fiberoptic instruments and the original Bullard design have no external viewing mechanism they can all be attached to an endoscopic camera.

The marriage of a hypopharyngeal perspective above the epiglottis with a means of displaying this image adds two very meaningful things to airway management: first, theses devices provide a bigger and closer view of the larynx than achieved by direct laryngoscopy; and second, they allow the operator and others to easily visualize tracheal tube passage into the larynx. These two features have very significant benefits in teaching settings and also in anticipated difficult airways.

A variable during intubation with these devices is the method of tube delivery.  Devices like the Glidescope and McrGrath require tube insertion to be done entirely on the monitor, since there is no direct line of sight to the larynx.  A stylet is necessary to match the curve of these instruments and introduce the tube around the curve of the tongue.  Tube insertion with the C-Mac can be partially or even completely done under direct visualization (like a standard laryngoscope, with or without a stylet), while using the monitor for verification of placement.  The AirTrtaq and the Pentax Airway Scope have taken the engineering of an intubation device one step further by combining the imaging mechanism with a tube delivery track.  With each of these devices stylets are not used. While this simplifies the procedure, it also means that tube delivery is restricted to how the device is aligned with the target, and there are some tricks to getting the tube to move where it needs to.  The Airway Scope even has a targeting mechanism integrated into the video screen.