The Bullard laryngoscope (CIRCON ACMI, Stamford, CT) was designed
by Dr. Roger Bullard; former Director of Obstetrical Anesthesia
at the Medical College of Georgia. It can be an important device
in the management of the difficult airway. It is a rigid laryngoscope
that combines a curved blade with fiberoptic visualization into
a simple and easy-to-use handheld unit (Figure 7-1).
The Bullard laryngoscope.
The contoured handle is the central structure of the Bullard
laryngoscope (Figure 7-2). The proximal handle contains an 11 French
(3.7 mm) working port, a site to attach the light source, and a visualization
port. A traditional laryngoscope handle attaches to the Bullard’s
handle and is used as the light source. Alternatively, a fiberoptic
light source may be used by attaching an adapter to this site. Incorporated
into the handle is an 11 French port, which allows oxygen insufflation,
suctioning, administration of pharmaceuticals, or the passage of
a guidewire to promote tracheal intubation.1,2 An optical
port on the Bullard’s handle allows a 55 ± 5
degree field of view from the tip of the blade.1,2 Attached
to the distal handle is a curved metal blade for intubating. The
curved blade is designed to conform to the shape of the oropharnyx.
It is similar in shape to a Macintosh blade. A fiberoptic bundle
runs through the handle and along the contour of the blade to allow
visualization of the vocal cords and tracheal intubation without
a direct line of sight.
Anatomy of the Bullard laryngoscope.
The intubating mechanism involves a dedicated stylet that attaches
to the handle (Figure 7-3). The Bullard laryngoscope comes with
an accessory stylet, which attaches to the fiberoptic bundle between
the eyepiece and the handle. The stylet aligns beneath the flange
of the blade. There is a small central opening in the dedicated
stylet (4.5 mm in the adult model, 3.6 mm in the pediatric long
model) large enough to allow the passage of a guidewire.
The Bullard laryngoscope comes in three sizes (Figure 7-4). The
largest model has a blade 2.5 cm wide, which extends 2.7 cm beyond
the fiberoptic bundle and is used for adults and children over 10
years of age. The pediatric model is used for neonates, infants,
and small children. It has a blade that is 1.3 cm wide and extends
0.6 cm beyond the fiberoptic bundle. The pediatric long model is
used in larger children up to 10 years of age. The blade is 1.6
cm wide and extends 1.4 cm beyond the fiberoptic bundle.1...