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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).

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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.

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FIGURE 7-2
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Anatomy of the Bullard laryngoscope.

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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.

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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...

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