The standard Macintosh laryngoscope was introduced in 1943. It has a relatively short curved blade designed to rest in the vallecula and lift the epiglottis. Several alternative laryngoscope blades are available, some of which are described below.
Miller. Straight bladed laryngoscope with a slight curve at the tip. The blade is longer, narrower and smaller at the tip and is designed to trap and lift the epiglottis
McCoy. The McCoy levering laryngoscope (McCoy 1993) has a 25 mm hinged blade tip controlled by a spring loaded lever on the handle of the laryngoscope which allows elevation of the epiglottis without the use of excessive forces on the pharyngeal tissues
Bullard. The Bullard laryngoscope is a rigid bladed indirect fibre-optic laryngoscope with a shape designed to match the airway. The fibre-optic bundle passes along the posterior aspect of the blade and ends 26 mm from the distal tip of the blade allowing excellent visualisation of the larynx. Intubation can be achieved using an attached intubating stylet with pre loaded endotracheal tube. Although this device requires a considerable amount of practice it is particularly useful in those patients with upper airway pathology, limited mouth opening or an immobile or unstable cervical spine
Prism. The Huffman prism is an example of a laryngoscope using refraction to aid visualisation of the larynx. It employs a modification of the Macintosh blade whereby a block of transparent plastic in a prism shape is attached to the proximal end of the blade. The ends of the prism are polished to provide optically flat surfaces, the nearest to the eye being cut at 90 degrees to the line of vision and the distal surface at 30 degrees. The net result to the view obtained is a refraction of approximately 30 degrees.
Figure I.8 Laryngoscope blades
Polio. The Polio blade was originally designed to enable patients in an iron lung to be ventilated. In the UK the "polio blade' is actually a 90 degree adaptor located between the handle and blade of a standard Macintosh laryngoscope. It allows the easier introduction of the blade in situations where the chest gets in the way of the handle.
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