The handle for the Phillips laryngoscope is the same for the Macintosh laryngoscope. The Phillips blade integrates the straight blade design with a gentle curved distal tip specifically designed for direct lifting of the epiglottis to provide greater visibility. It incorporates a wider C-shaped cross section to provide an improved view of the laryngeal structures, and sufficient room for the passage of the tracheal tube compared to the Miller blade.
The battery and the light source of the laryngoscope and the cuff of the endotracheal tube should be checked for optimal condition prior to their use.
Oxygenation of the patient is required prior to any intubating attempt. The patient's head and neck should be placed in a maximum extension with a slight rotation of the head to the left. As with the curved Macintosh laryngoscope, the technique can be divided into four steps insertion of the laryngoscope and passage along the paraglossal gutter, optimization of the position of the laryngoscope and the view of the larynx, passage of the tracheal tube, and confirmation of intubation.
The laryngoscope handle is held by the left hand and the laryngoscope is inserted lateral to the tongue on the right and advanced carefully along the paraglossal gutter. Continued application of a moderate lifting force with a laryngoscope during its passage helps to maintain anterior displacement of the mandible and control the tongue, and to reduce contact between the laryngoscope and the maxillary teeth.
As the laryngoscope is advanced, the epiglottis comes into view and the tip of the laryngoscope is passed posterior to the epiglottis. The direction of lifting of the laryngoscope should be at its right angles to the line of the straight laryngoscope blade, and is produced by the lifting in the line of the laryngoscope handle. The laryngoscope is then lifted gently, and the glottis can be seen readily.
If the glottis cannot be seen clearly, external pressure applied to the larynx can be used to improve the view. Once the glottis is visualized, the endotracheal tube is introduced at the right corner of the mouth around the lumen of the blade. An assistant can help to retract the cheek at the angle of the mouth to make room for the tube placement through the mouth.
The endotracheal tube is then placed through the chords and advanced until the cuff passes beyond the chords. Following intubation, the cuff is inflated and correct placement of the tube should be confirmed using end-tidal CO2 and auscultation.
Segment:4 Trouble Shooting.
Visualization of the glottis is generally easier with the Phillips straight blade laryngoscope. But the placement of the endotracheal tube through the glottis can be challenging as the glottic view is generally obscured by the advancing endotracheal tube.
The Eschmann introducer is particularly useful when the glottic opening cannot be clearly seen using a laryngoscope.
Tracheal intubation under direct laryngoscopy remains a gold standard technique, which is generally easy to perform. However, in order to have a successful intubation using the Phillips laryngoscope, careful preparation of the patient and the device as well as proper technique are necessary.