Laryngoscopy

If the laryngoscope is held in the left hand, it is then passed into the right side of the mouth. The right-angled blade of the Macintosh laryngoscope then aids in laryngoscopy by keeping the tongue out the way to the left-hand side of the mouth. The tip of the blade is passed back in the mouth over the posterior tongue, and directed toward the midline posteriorly. To improve the view the laryngoscope is lifted vertically, not pivoted. If the laryngoscope is pivoted, the view will not be as good and there is more likely to be damage to the patient's upper teeth.

Once the laryngoscope is fully advanced into the vallecula, anterior to the epiglottis, the epiglottis will be seen clearly. As the laryngoscope is elevated, directly behind (below) the epiglottis is the glottic opening surrounded by the aryepiglottic folds laterally and the arytenoid cartilages, covered by the fold, posteriorly. Deep to this are the vocal cords, which are whitish in appearance and are abducted and immobile if the patient has been given neuromuscular blockade.

The endotracheal tube is passed between the cords until the cuff has disappeared below them. The cuff should then be inflated, and the tube secured and connected to the ventilating circuit. The laryngoscope is removed, while the endotracheal tube is held to prevent its accidental displacement.

If laryngoscopy is adequate but there is difficulty in introducing the endotracheal tube into the glottis, the gum elastic bougie may be used. This is advanced into the trachea, held firmly while the endotracheal tube is threaded over it into the trachea, and then removed carefully while the tube is held in place.

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