• H Katoh, J Nishiyama, M Takiguchi, Y Yamasaki, and M Yamamoto.
• Department of Anesthesiology, Tokai University School of Medicine, Isehara.
• Masui. 1993 Feb 1;42(2):237-41.

AbstractThe Bullard laryngoscope with its introducing stylet is useful in a variety of patients with airway problems, but it poses difficulties in some cases where an endotracheal tube (ETT) catches on the ary-epiglottic fold and cannot be advanced into the trachea. This difficult may be avoided by slightly angulating the tip of the ETT so that it is directed in a better alignment toward the rima glottis. The efficacy of the two methods of angulation was studied. One hundred and eight patients were randomly assigned to one of three groups. In group 1 (control, 36 patients), the ETT was attached naturally to the stylet with the bevel facing left. In group 2 (36 patients), the ETT was hooked on the distal end of the stylet at the Murphy eye, as recommended by the manufacturer. In group 3 (36 patients), the ETT was set over the stylet after being rotated 180 degrees so that the bevel was directed to the right. Intubation on the first attempt was successful in 56% of group 1, 83% in group 2 and 100% in group 3. The patients in groups 1 & 2 in whom first attempt failed were all successfully intubated on the second trial with the method used in group 3. This method (180 degrees rotation of the ETT on the stylet), is applicable to any ETT with or without the Murphy eye.

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