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GENERAL ARTICLES

Balloon Versus Conventional Laryngoscopy: A Comparison of Laryngoscopic Findings and Intubation Difficulty

Department of Anesthesiology, Evangelismos General Hospital, Athens, Greece

Address correspondence and reprint requests to Spyros D. Mentzelopoulos, MD, 2A Kypseli Str., 11362, Athens, Greece. Address e-mail to sdm{at}hol.gr

We compared laryngeal aperture (LA) exposure and endotracheal intubation difficulty scale (IDS) scores between balloon-assisted and conventional laryngoscopy. Thirty-two anesthetized and paralyzed elective surgery patients underwent laryngoscopy with a standard number 4 and a modified number 4 curved blade carrying a 6F Fogarty catheter. The balloon laryngoscopy technique included modified blade tip insertion into the vallecula, Fogarty catheter balloon inflation with 2 mL of air, and blade elevation until LA exposure maximization. On maximal LA exposure with both blades, the LA views were videotaped with a camcorder aligned to blade light source and the exposed LA areas measured electronically. The IDS scores were determined on passing the tip of an endotracheal tube through the vocal cords. The patient head position, the angle of laryngoscope handle elevation, and the time available for airway instrumentation were standardized. The data from 27 patients were analyzed. The exposed LA areas were significantly larger with balloon laryngoscopy than conventional (median, interquartile range: 0.94, 0.65–1.80 cm² vs 0.52, 0.39–1.46 cm² respectively) (P = 0.027), and the IDS scores lesser (median, interquartile range: 0, 0–1 vs 1, 0–2 respectively) (P = 0.012). We concluded that balloon laryngoscopy facilitates elective airway management.

Implications: The results of this study show that balloon-assisted laryngoscopy facilitates the airway management of elective surgery patients by providing greater laryngeal exposure than conventional laryngoscopy. Thus, the routine use of a curved blade carrying the inflatable balloon of a 6F Fogarty catheter on its distal end is recommended.

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