This document provides information on the use of a laryngoscope, including indications, contraindications, and procedures. It is used prior to intubation in infants for conditions like neonatal asphyxia or respiratory distress, and in older children for resuscitation or anesthesia. Direct laryngoscopy is also used to examine the larynx for issues like cord palsy or foreign bodies. The procedure involves lubricating and advancing the laryngoscope behind the epiglottis while examining various structures, with risks including mechanical injury or stimulating a vago-vagal response.

1. LARYNGOSCOPE

3. INDICATIONS
 In Infants
Prior to endotracheal intubation in:
• Neonatal asphyxia
• Meconium aspiration
• Respiratory distress syndrome
• Tracheo oesophageal fistula
• Mechanical ventilation

4. .
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

5. Contraindications
• Diseases or injuries of cervical spine.
• Moderate or marked respiratory obstruction.

6. PROCEDURE
1. 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

8. Following structures are examined serially:
1. Base of tongue
2. Right and left valleculae
3. Epiglottis
4. Right and left pyriform sinuses
5. Arypeiglottic folds
6. Arytenoids
7. Post cricoid region
8. False cords
9. Anterior and posterior commissure
10.Ventricles and vocal cords
11.Subglottic area

9. 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.