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The Cardiff paediatric laryngoscope and its ‘non‐conforming’ siblings

2005; Wiley; Volume: 60; Issue: 7 Linguagem: Inglês

10.1111/j.1365-2044.2005.04271.x

1365-2044

Rachel Jones, Peter Lloyd Jones, C. Gildersleve, James Edwin Hall, N. Manners,

Foreign Body Medical Cases

We would like to clear up any confusion that may exist with the marketing of the Cardiff paediatric laryngoscope. The Cardiff blade used in our study was a prototype made by Truphatek, Israel, to one of the authors' (P.L.J.) design specifications [1]. This design is now marketed as the PROACTTM Cardiff Pro 1 (Proact Medical, Kettering, UK). The manufacturers refer to this as an infant blade. However, it was specifically designed as a universal blade, to be used from birth to adolescence. Our study investigated children from 0 to 16 years and the results clearly show that the blade can be used throughout this age range. It has also come to our attention that Size 0 and 00 Cardiff Pro blades are also available. We have not been involved in the development of these and are not aware of any studies in human subjects using these smaller sizes. The design specifications of the Cardiff blade are clear in our paper and so, by definition, these smaller blades cannot be considered to be 'Cardiffs'. A disposable version of the blade is now available, the PROACTTM MetalmaxTM Cardiff PRO 1. Unfortunately, this useful development does not conform to the original specifications, which raises questions about its performance compared with the original blade. The mini halogen bulb has been replaced with a standard sized bulb. This larger bulb encroaches significantly on the laryngeal view and also cuts down the available space for instrumenting the airway (Fig. 2). In the open position the original blade forms an angle of 85° to the handle; this is to encourage lifting rather than levering of the blade. The disposable version, however, forms a 90° angle in the open position, and appears to require a greater lifting force to achieve the same view as the original blade. To investigate these problems fully we are about to undertake a formal comparison of both blades. Laryngoscopy of a junior manikin showing the views obtained with the standard Cardiff blade (A) and the disposable version (B). Sir Robert Macintosh's original blade design was modified during mass production, together with the addition of two new sizes with which he had no involvement [2]. Should we feel honoured that the Cardiff design has been treated with the same respect? On a more serious note, with the increase in disposable anaesthetic equipment, there seems to be a wide variation between manufacturers with regard to laryngoscope blade shape and quality [3, 4]. We believe that manufacturers should be required to adhere to the design specification of any named blade to ensure that the product performs as well as those samples that were clinically tested. Where a significantly different item, such as a disposable alternative, is offered under the same name, it should be clinically tested for compliance with the performance of the original before being made commercially available. When confronted with a difficult airway we need to be assured that the disposable equipment we use will reproduce the quality and view of the standard blade. I would like to thank Dr Jones and his colleagues for their comments and observations regarding the disposable PROACT Cardiff-PRO Laryngoscope blades. We have taken immediate action to alter the range of Cardiff-PRO Disposable Blades to conform exactly to the original blade's 85° angle to the handle. The bulbs are also being changed back to the original smaller type as recommended. After use of the original size 1 Cardiff-PRO blades some anaesthetists requested smaller sizes of blade. We therefore offered a size 0 and 00 blade to these and other anaesthetists who may decide that they require them. One of the very interesting aspects regarding laryngoscopes, intubation and many other areas of medicine is that a product which suits one clinician does not necessarily match the needs or technique of another. We therefore strive as a company to offer clinicians all the choices of product we can and trust in them to use the product that they deem most suitable for the task in their hands. We would agree with Dr Jones that all blades should ideally adhere to a clinically proven form and look forward to working closely with the 'Cardiff Team' in order to achieve this.