Untitled Document

Letter to Editor

Bull Emerg Trauma 2014;2(1):62-63.

Amenable Intubation by Disposable Laryngoscope Blades

Saeid Pasban-Noghabi1*, Ali Reza Moslem2, Naser Godarzi3

1Department  of Nursing Education, Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
2Department  of Anesthesiology,  School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3Department  of Psychology, AJA University of Medical Sciences, Tehran, Iran

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Corresponding author:Saeid Pasban-Noghabi
Address: Department of Nursing Education, Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran.   Tel: +98-915-6554507, e-mail: Pasban_saeid@yahoo.com

Received: December 5, 2013
Accepted: December 26, 2013

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Please cite this paper as:
Pasban-Noghabi S, Moslem AR, Godarzi N. Amenable Intubation by Disposable Laryngoscope Blades. Bull Emerg Trauma. 2014;2(1):62-63.

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Keywords: Orotracheal intubation; Disposable blade; Laryngoscope.

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Dear Editor
Endotracheal intubation may be required for every patient  under  general anesthesia (GA). Direct laryngoscopy is a routine method for endotracheal intubation  in patients. Various blades are used for intubation  depending on the choice of anesthetist and patient's  conditions  [1].  These  laryngoscope blades  can  trigger  infection  among patients  [1]. Nowadays it is believed that the standard method for sterilization of laryngoscope blades does not destroy all existing pathogens [2]. Using cheap disposable blades can eliminate the infection risk [2]. The main reason for using the disposable laryngoscope blades is to  minimize  the  risk of infection  transmission between the patients. Several cases of prion transfer between  patients  have been reported  after  blood transfusion, and it is well known that laryngoscopes can become contaminated with blood during use [3]. Therefore, single-use devices are an obvious solution to the problem. However, plastic blades do not have the same physical characteristics as metallic ones. Shape, size, light sources, and stiffness are different between  blade  types  [4].  Most  of  the  operators involved in this study believed that stiffness of the plastic blades was less than that of metallic ones and might be the main factor influencing the quality of laryngoscopy.

Modir  and  his colleagues [5] evaluated duration and success of intubation in a clinical trial involving 320 patients aged over 10 years. After induction  of general  anesthesia, endotracheal  intubation was done using disposable plastic or metal reusable blades. Average time for reusable metal laryngoscope blades was 13.1±4.29 minutes and it was 16.4±8.1 minutes   for  disposable  plastic  blades  (p<0.001) [5].  Using  plastic  disposable  blades, outside  the hospital emergency, reduced the success rates of first attempt intubation  [6]. Amour et al. compared the disposable blades and metal reusable blades in rapid sequence induction (RSI). The findings showed that the disposable metal blades were more useful than reusable metal blades in RSI [7]. In another clinical study conducted in operation room (OR) the failure rate for RSI was 17% for disposable plastic blades and 3% for disposable metal blades [7].
In emergency department and out-of-hospital care, single use  disposable  plastic  laryngoscope blades are now available and may be used in daily practice because of the strong suggestion that single-use devices should be used when mucosal contact occurs. However, the effectiveness of the 2 types of blade has not been compared in the emergency setting. If the plastic blades lead to a lower intubation success rate and make intubation  more difficult, any theoretical benefits of avoiding rare infectious diseases are to be negated.

In short, the metal disposable blades facilitated the intubation,  whereas the plastic blades increase the time of intubation.  Further studies on this subject provide more definitive information.

Conflict of Interest: None declared.

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References

  1. Miller RD, Pardo MC. Basic of anesthesia. 6th ed. Philadelphia: Churchill Livingstone Elsevier; 2011.
  2. Darabi ME, Mireskandari SM, Salamati P, Ramezani M, Rahimi E. Comparison of laryngoscopic conditions by means of disposable and metalic macintosh blades in pediatric patients. Journal of Isfahan Medical School 2009;97(27):223-31. [in Persian]
  3. Modir H, Khalili M, Yazdi B, Moshiri E, Akbari A. Comparison of the efficiency of single-use plastic and reusable metal laryngoscope blades in orotracheal intubation during rapid-sequence induction of anesthesia. Arak University of Medical Sciences Journal 2012;14(6):97-103.
  4. Jabre P, Leroux B, Brohon S, Penet C, Lockey D, Adnet F, et al. A comparison of plastic single-use with metallic reusable laryngoscope blades for out- of-hospital tracheal intubation. Ann Emerg Med 2007;50(3):258-63.
  5. Amour J, Le Manach YL, Borel M, Lenfant F, Nicolas-Robin A, Carillion A, et al. Comparison of single-use and reusable metal laryngoscope blades for orotracheal intubation during rapid sequence induction of anesthesia: a multicenter cluster randomized study. Anesthesiology 2010;112(2):325-32.

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Journal compilation © 2014 Trauma Research Center, Shiraz University of Medical Sciences