Internet Journal of Airway Management

 

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Volume 2 (January 2002 to December 2003)



Upsher Laryngoscope with Improved Tip Design

 

 

Ernst Zadrobilek, MD

 

Associate Professor of Anesthesia and Intensive Care, Chairman of the Austrian Working Group for Airway Management and Director of the Department of Anesthesia and Intensive Care, Empress Elisabeth Hospital of the City of Vienna, Vienna, Austria.

 

Address correspondence and comments to Ernst Zadrobilek.

 

Received from the Department of Anesthesia and Intensive Care, Empress Elisabeth Hospital of the City of Vienna, Vienna, Austria.

Statements

Support was provided solely from institutional sources. The author has no financial relationship with the manufacturers and distributors of the Upsher laryngoscope and other rigid fiberoptic laryngoscopes.

 

Key Words  

Tracheal intubation: Upsher laryngoscope (improved version)

 

Published: July 24, 2003.

 


 

The correct citation of this communication of new equipment and techniques is:

Ernst Zadrobilek. Upsher laryngoscope with improved tip design. Internet Journal of Airway Management 2, 2002-2003.

Available from URL: http://www.adair.at/ijam/volume02/newequipment01.htm

Date accessed: month day, year.

 


Last updated: August 10, 2003.


 

The Upsher laryngoscope (UL; manufactured by Mercury Medical, Clearwater, Florida, United States) is a rigid fiberoptic instrument that allows visualization of the laryngeal aperture without requiring alignement of oral, pharyngeal, and laryngeal axes and and the need for extending the head and neck or widely opening the mouth. The UL incorporates a tube-guide channel (approximately C-shaped in cross section opened to the right) to guide the tracheal tube (TT). Difficulties with tracheal intubation using the original UL (the UpsherScope) were encountered due to the anatomically incorrect blade curvature and the misalignment of the of the fiberoptic image bundle and the distal end of the blade (1-4). Recently, a new version of the UL (the UpsherScope Ultra) has been developed; alterations in the blade curvature and design were performed by the manufacturer in order to ease the advancement of the TT through the  laryngeal aperture into the trachea.    

 

Upsher Laryngoscope with Improved Tip Design

 

In general, the construction and function of the new UL are comparable with the original UL. The focusing control in the eyepiece was abondoned, so that the entire unit (including the proximal optical system) can be immersed in liquid solutions for disinfection.

 

Distinct modifications were performed by the manufacturer in the shape of the blade: the angle of the curvature is closer to 90 degrees (resulting in better alignment  of the fiberoptic image bundle and the distal end of the blade) and the lower horizontal flange is elonged far beyond the tube-guide channel. The improved curvature and particularly the elonged lower horizontal flange of the blade may now guide the TT close to the laryngeal aperture.

 

The author of this communication [experienced in tracheal intubation with the original UL (4)] performed 20 tracheal intubations with the new BL and was sucessful at the first attempt in all patients. Partial retracting of at least the tip of the epiglottis was an essential maneuver for proper alignment of the device with the laryngeal aperture. During advancement, the TT occasionally impinged on laryngeal structures (usually on the right aryepiglottic fold or arytenoid cartilage); a backward, upward, and to the left movement of the UL was then required for passing the laryngeal aperture.

 

In conclusion, the original UL did not entirely meet the demands on an alternative device for tracheal intubation in the management of the difficult airway. The author of this communication suggests that the new version of the UL with improved tip design may fulfill these features. Clinical studies are necessary to support this suggestion.

   

 

References

  1. Fridrich P, Frass M, Krenn CG, Weinstabl C, Benumof JL, Krafft P. The UpsherScope in routine and difficult airway management: a randomized, controlled clinical trial. Anesth Analg 85:1377-1381, 1997.

  2. Pearce AC, Shaw S, Macklin S. Evaluation of the UpsherScope. A new rigid fibrescope. Anaesthesia 51:561-564, 1997.

  3. Yeo V, Chung DC, Hin LY. A bougie improves the utility of the UpsherScopeTM. J Clin Anesth 11:471-476, 1999.

  4. Zadrobilek E, Andel H. Orotracheal intubation with the original version of the Upsher laryngosope using an intubating catheter. Internet Journal of Airway Management 2, 2002-2003. Date accessed: August 10, 2003.


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