Original contributionComparison of the Magill forceps and the Boedeker (curved) intubation forceps for removal of a foreign body in a Manikin☆
Introduction
A foreign body lodged in the upper airway and pharynx is a common clinical problem, especially in children [1], [2]. The foreign body is usually removed using Magill forceps and direct laryngoscopy (DL) [1], [3]. While standard laryngoscopes provide a direct view along the line of sight (10° field of view), with videolaryngoscopy a much wider (60°) field of view may be achieved (personal communication, Karl Storz).
Conventional (straight shaft) Magill forceps are designed to operate in direct line of sight. However, when using videolaryngoscopy, the working end of this instrument does not pass into the laryngoscopist's field of view. A curved intubating forceps (Boedeker Intubation Forceps; Karl Storz GmbH & Co. KG, Tuttlingen, Germany) was developed to provide the operator with the full field of view offered by videolaryngoscopy. We performed a comparison of the Magill and Boedeker Intubation Forceps for removal of a foreign body in a manikin.
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Materials and methods
After Institutional Review Board approval from the University of Nebraska Medical Center, 16 anesthesia staff and one respiratory therapist participated in this study. A foreign body (penny) was placed between the vocal cords of a Laerdal Difficult Airway Manikin (Laerdal, Wappingers Falls, NY, USA). The tongue was inflated, creating a Grade 4 Cormack-Lehane (CL) view of the glottis for direct laryngoscopy [4]. Consequently, removal of the foreign body during direct laryngoscopy was not
Results
The videolaryngoscopic views were compared in two scenarios: both with the (straight) Magill forceps and the (curved) Boedeker forceps. When the Magill forceps were used, it was noted that to see the tip of the forceps, the view of the glottic opening was sacrificed (Fig. 1). When using the Boedeker forceps, the entire glottic opening was visible along with the tip of the forceps (Fig. 2). The CL scores obtained by participants using the Magill (mean = 1.75, SD = 0.577; n = 17) and Boedeker
Discussion
Foreign body removal from the upper airway or pharynx of patients is not an uncommon procedure. This is most commonly accomplished by direct laryngoscopy and grasping the foreign object with a straight-shaft Magill forceps. With the advent of the videolaryngoscope, the field of vision during laryngoscopy was significantly expanded (60° indirect view vs 10° view during direct laryngoscopy). This creates the need for instruments that can extend beyond the usual field of vision (straight line)
Acknowledgments
The authors would like to acknowledge Gail Kuper for her assistance in data collection. The views, opinions, and/or findings contained in this publication are those of the authors and do not necessarily reflect the views of the University of Nebraska Medical Center, the Department of Veterans Affairs, or the Cleveland Clinic.
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Competing interests: The University of Nebraska Board of Regents holds all intellectual properties associated with this project. All manuscript fees are paid by the University of Nebraska.
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These authors contributed equally to this work.