.In Older Children Prior to endotracheal intubation:• Resuscitation• During admoinistration of general anaesthesia• Epiglottitis• Kerosene poisoning Direct Laryngoscopy• In cord palsy• Anatomical lesions• Foreign body
Contraindications• Diseases or injuries of cervical spine.• Moderate or marked respiratory obstruction.
PROCEDURE1. Gauze piece placed on upper teeth to protect against trauma.2. After lubrication, the laryngoscope is held by the handle in the left hand. Right hand is used to retract the lips and guide the scope.3. It is introduced by one side of the tongue which is pushed to the opposite side till posterior third of tongue is reached.4. It is advanced behind the epiglottis and lifted forward without levering it on the upper teeth or jaw
Following structures are examined serially:1. Base of tongue2. Right and left valleculae3. Epiglottis4. Right and left pyriform sinuses5. Arypeiglottic folds6. Arytenoids7. Post cricoid region8. False cords9. Anterior and posterior commissure10.Ventricles and vocal cords11.Subglottic area
Complications• Mechanical injury injury to local tissues like teeth,tongue,palate• Stimulation of posterior pharyngeal wall may cause vago-vagal episode leading to hypoxia, bradycardia.• Hyperextension of neck may cause damage to cervical spine.