Handle old laryngoscopes with care.

To cite: Vaidya S, Gupta SL, R P, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014207084 DESCRIPTION A 30-year-old woman with fibroid uterus was operated on for myomectomy under general anaesthesia. Preoperative evaluation revealed adequate mouth opening, neck extension, thyromental distance and Mallampati grade 1. In the operating room, anaesthesia was induced with fentanyl and propofol under standard monitoring. Muscle relaxation was achieved with vecuronium. Laryngoscopy was attempted with a size 3 McIntosh laryngoscope blade after mask ventilating the patient for 3 min. Laryngoscopy revealed a Cormack Lehane grade 3 view. External laryngeal manipulation with increased axial force along the laryngoscope handle was attempted. During this time, the laryngoscope blade along with the hinge piece separated from rest of the handle at the weld line. Fortunately, none of the batteries or other parts slipped into the patient’s oropharynx. The patient was mask ventilated and laryngoscopy was attempted with another laryngoscope. Subsequent tracheal intubation was successful with help of a stylet. On closer examination of the damaged laryngoscope handle, breakage was found along the line where the knurled barrel of the handle was welded into the proximal cast fitting of the hinge piece (figures 1 and 2). Failure of welding can be attributed to laryngoscope handle wear; the laryngoscope had clearly been in use for many years. The weld line between the hinge piece and knurled barrel of the handle acts as a fulcrum and is subjected to a force of 10–30 newton during laryngoscopy. This force can reach 100 newton during a difficult laryngoscopy and in our case could have caused the failure of the welding. Breakage at hinge and ingestion and loss of rivet in a MacCoy blade have been reported earlier.