AU2015101198A4 - Laryngoscope - Google Patents

Abstract

Abstract A laryngoscope comprising a handle, a blade holding element, a detachable blade, means for viewing the laryngeal inlet of a patient and means for adjusting the viewing field. The means for adjusting the viewing field may comprise a light refracting means. Alternatively, in embodiments in which the viewing means comprises at least two fixed cameras elements directed to at least two different viewing fields, the means for adjusting the viewing field may comprise means for switching from one camera to the other or, in embodiments in which the viewing means comprises a movable camera element, the means for adjusting the viewing field may comprise mechanical or electronic means for controlling the movement of the camera. A method for viewing the laryngeal inlet of a patient using a laryngoscope comprising the step of adjusting the viewing field is also covered.

Description

LARYNGOSCOPE This application relates to a laryngoscope and more particularly to a video laryngoscope. 5 Whereas a conventional laryngoscope is used by a physician to visualise the path to the trachea by manipulating the patient's anatomy to establish a direct line of sight, a video laryngoscope provides a view of the glottis and trachea without the need for such manipulation, which is clearly advantageous. 10 In recent times video laryngoscopes have also been provided that have removable, disposable blades, to remove the need for sterilisation. A laryngoscope is a device which is used by clinicians during tracheal intubation and that assists with intubation by allowing the clinician to visualise the path of the endotracheal tube 15 as it passes through the glottis towards th'e trachea. In its most recent form a laryngoscope comprises a handle and a blade and often includes a light source. Some laryngoscopes are also provided with viewing devices such as fibre optics and cameras. These are called video laryngoscopes. 20 Most intubations are straightforward and clinicians use a laryngoscope with a straight or curved blade which is positioned into the patient's airway. However, some patients are known to be difficult to intubate, especially if there are anatomical abnormalities (e.g. if the larynx lies particularly anteriorly) or if there are injuries. Intubation of these patients is more successful using a blade with a different shape, such as the "difficult blade" described in more 2 detail below. A blade for use in difficult intubations preferably has a curved portion that smoothly follows the anatomical shape of the patient's airways, a ventrally displaced distal extension to allow a better view of the laryngeal inlet and a paddle to guide the endotracheal tube towards the laryngeal inlet. 5 There is currently no universal blade that can be used in all cases and a number of different blades may be desired and beneficial so that the clinician can visualise the laryngeal inlet with a choice of blade shapes depending upon clinical requirements and personal expertise and preference. Since existing video laryngoscopes are necessarily used with one compatible 10 blade shape, the user will need to use an entirely different laryngoscope depending on the situation. For example, a clinician could insert a video laryngoscope with a standard curved blade into a patient and upon insertion realise that abnormalities are present which require a modified blade. He or she would then need a second video laryngoscope with a modified blade to visualise the laryngeal inlet, thereby adding to the cost of the equipment required to 15 perform efficiently. The blades are often disposable and relatively cheap, whereas the handle comprising the viewing means is generally expensive. There is therefore a need for a laryngoscope which may be used with different blade shapes. It is an object of the present invention to overcome or ameliorate at least one of the 20 disadvantages of the prior art, or to provide a useful alternative. Any discussion of the prior art throughout the specification should in no way be considered as an admission that such prior art is widely known or forms part of common general knowledge in the field.

2a According to a first aspect, the present invention provides a laryngoscope comprising: a handle, an elongate blade holding element, attached to the handle, wherein the blade holding element comprises a viewing means, and 5 wherein the laryngoscope further comprises at least two different detachable blades, wherein the at least two different detachable blade are slidable relative to the blade holding element, wherein at least one of the blades is for difficult intubations, wherein the blade for difficult intubations comprises a distal extension, wherein the blade for difficult intubations further comprising means for altering the field of view of the viewing means, wherein the means for 10 altering the field of view adjusts the field of view such that the tip of the distal extension is visible. According to a second aspect, the present invention provides a method for viewing the laryngeal inlet of a patient using the laryngoscope according to the first aspect, the method 15 comprising assessing a patient, determining the correct blade to view the laryngeal inlet of the patient, fitting the blade selected in order to achieve the required viewing angle. Unless the context clearly requires otherwise, throughout the description and the claims, the words "comprise", "comprising", and the like are to be construed in an inclusive sense as 20 opposed to an exclusive or exhaustive sense; that is to say, in the sense of "including, but not limited to". According to a first embodiment of the invention, there is provided a laryngoscope comprising a handle, a blade holding element, a detachable blade and means for viewing the 25 laryngeal inlet of a patient, the laryngoscope further comprising means for adjusting the viewing field.

3 Preferably, the laryngoscope is configured to be usable with at least two different detachable blades, including for example straight blades, curved blades or blades specifically designed for difficult intubations. 5 The blade may comprise a sleeve portion that completely or partially surrounds the blade holding element and a distal extension which is preferably integrally moulded with the sleeve portion. Such integrally moulded blades are cheaper to produce, more robust and less prone to contamination if reused. 10 The detachable blade may further comprise means for guiding the endotracheal tube towards the tip of the distal extension. This is particularly useful where the clinician faces a difficult and complex intubation situation. In a preferred embodiment, the viewing means comprises at least one fixed camera located at 15 the distal end of the blade holding element. Preferably, means for adjusting the viewing field comprises a light refracting means, such as a prism or a wedge prism. In another preferred embodiment, the viewing means comprises at least two fixed cameras elements directed to at least two different viewing fields, Preferably, the laryngoscope further 20 comprises means for switching from one camera to the other so that for example the first camera is used for when the laryngoscope is fitted with a standard blade and the second camera when a difficult blade is used.

4 In yet another embodiment, the viewing means comprises a movable camera element. Preferably, the laryngoscope further comprises mechanical or electronic means for controlling the movement of the camera. For example, the distal end of the sleeve of the blade may comprise a window positioned such that, in use, the camera is positioned to visualise the 5 laryngeal inlet of the patient. According to a second embodiment of the invention, there is provided a method for viewing the laryngeal inlet of a patient using a laryngoscope comprising a handle, a blade holding element, a detachable blade and means for viewing the laryngeal inlet of a patient, comprising 10 the step of adjusting the viewing field. The invention will be further described with reference to the drawings, in which: Figure 1A to 1 C show a laryngoscope according to the invention; Figure 2A shows a standard curved blade; 15 Figure 2B shows a blade for difficult intubations; Figure 3 shows part of a laryngoscope according to a first embodiment of the invention; Figure 4a shows the laryngoscope of figure 3 fitted with a short standard curved blade; Figure 4b shows a view obtained with the laryngoscope of figure 4a; Figure 5a shows the laryngoscope of figure 3 fitted with a long standard curved blade; 20 Figure 5b shows a view obtained with the laryngoscope of figure 5a; Figure 6a shows the laryngoscope of figure 3 fitted with a difficult blade; Figure 6b shows a view obtained with the laryngoscope of figure 6a; Figure 7 shows part of a laryngoscope according to a second embodiment of the invention; Figure 8a shows the laryngoscope of figure 7 fitted with a short standard curved blade; 25 5 Figure 8b shows a view obtained with the laryngoscope of figure 8a; Figure 9a shows the laryngoscope of figure 7 fitted with a long standard curved blade; Figure 9b shows a view obtained with the laryngoscope of figure 9a; Figure 1 Oa shows the laryngoscope of figure 7 fitted with a difficult blade; S Figure lOb shows a view obtained with the laryngoscope of figure IOa; Figure 1 1 shows part of a laryngoscope according to a third embodiment of the invention; Figure 12a shows the laryngoscope of figure I I fitted with a short standard curved blade; Figure 12b shows a view obtained with the laryngoscope of figure 12a without a prism; Figure 12c shows a view obtained with the laryngoscope of figure 12a with a prism; 10 Figure 13a shows the laryngoscope of figure 11 fitted with a short standard curved blade; Figure 13b shows a view obtained with the laryngoscope of figure 13a without a prism; Figure 13c shows a view obtained with the laryngoscope of figure 13a with a prism; Figure 14a shows the laryngoscope of figure 11 fitted with a short standard curved blade; Figure 14b shows a view obtained with the laryngoscope of figure 14a without a prism; 15 Figure 14c shows a view obtained with the laryngoscope of figure 14a with a prism; Figure 15 shows part of a laryngoscope according to a fourth embodiment of the invention; Figure 16a shows the laryngoscope of figure II fitted with a short standard curved blade; Figure 16b shows a view obtained with the laryngoscope of figure 16a without a prism; Figure 16c shows a view obtained with the laryngoscope of figure 16a with a prism; 20 Figure 17a shows the laryngoscope of figure 1I fitted with a short standard curved blade; Figure 17b shows a view obtained with the laryngoscope of figure 17a without a prism; Figure 17c shows a view obtained with the laryngoscope of figure 17a with a prism; Figure 18a shows the laryngoscope of figure 11 fitted with a short standard curved blade; Figure 18b shows a view obtained with the laryngoscope of figure ISa without a prism; 6 Figure 18c shows a view obtained with the laryngoscope of figure 18a with a prism; Figure 19 shows part of a laryngoscope according to a second embodiment of the invention; Figure 20a shows the laryngoscope of figure 9 fitted with a short standard curved blade; Figure 20b shows a view obtained with the laryngoscope of figure 20a; 5 Figure 21 a shows the laryngoscope of figure 9 fitted with a long standard curved blade; Figure 21 b shows a view obtained with the laryngoscope of figure 20a; Figure 22a shows the laryngoscope of figure 9 fitted with a difficult blade; and Figure 22b shows a view obtained with the laryngoscope of figure 20a; 10 In this application, the terms "distal part" and "proximal part" are used relative to the medical professional, i.e. the "distal part" is used to describe the part of the device that is inserted first into the patient. The terms "dorsal" and "ventral" are used relative to the patient, i.e. the "dorsal" side is used to describe the side directed to the back of the patient and the "ventral" side is used to describe the side directed to the front of the patient. 15 With reference to figures IA to IC, the laryngoscope (1) comprises a handle (2) for holding and manoeuvring the laryngoscope, a blade holding element (3) that is pivotally attached to the handle (2) and a detachable blade (4) that is attached the blade holding element (3). 20 The handle (2) is preferably made of stainless steel for robustness, although other materials such as metals or plastics may be used. At the proximal end, the blade holding element (3) is pivotally connected to the heel of the handle (2). The blade (4) is preferably hollow so that it can be fitted onto the blade holding element by sliding as can be seen in figures lA-IC 7 (described in more detail below). Preferably, the blade holding element (3) is elongated in shape and its outer contour corresponds substantially to the inner shape of the blade (4). The blade (4) is preferably integrally constructed and is for example produced by injection 5 moulding so that the cost of production is relatively affordable. The blade is preferably disposable to minimise or eliminate any risk of cross-contamination between patients. The blade may be made partially or completely with a transparent material in order to view the areas surrounding the laryngeal inlet. 10 The blade (4) may be straight (e.g. a Miller laryngoscope blade), curved (e.g. a Macintosh blade). Curved blades are generally preferred by clinicians because they are dimensioned to conform to the anatomical curve of the patient's throat. Figure 2A shows a standard curved Macintosh blade (4a) comprising a sleeve (5a) configured to surround, partially or completely, the blade holding element (3) and having a proximal end and a distal end. The 15 distal end of the sleeve preferably comprises a transparent window (6a). The blade (4a) further comprises a distal extension (7a) generally following the curve of the sleeve (5a). Figure 2B shows a blade (4b) with an enhanced longitudinal circumference. This type of blade (also referred to herein after as a "difficult blade") facilitates a view of the laryngeal 20 inlet and is used for difficult and complex intubations. The blade (4b) comprises a sleeve (5b) configured to surround, partially or completely, the blade holding element (3) and having a proximal end and a distal end. The distal end of the 8 sleeve preferably comprises a transparent window (6b). The blade (4b) further comprises a distal extension (7b) is displaced ventrally from the curve of the sleeve (5b). The difficult blade preferably comprises a guiding means for guiding the endotracheal tube 5 into the correct position in the patient's airway. In the blade (4b) shown in figure 2B, the guiding device comprises a paddle extending from the distal end of the sleeve (5b) and following the curve of the sleeve to direct the tube towards the tip of the distal extension (7b). As mentioned above, the difficult blade (4b) is recommended for difficult and complex 10 intubations and standard Macintosh blades (4a) are used in most straightforward intubations. The standard blades (a) have the advantages of being generally cheaper than the difficult blades (4b). In addition, the difficult blades (4b) can lead to laryngeal injury when unnecessarily used for a simple straightforward incubation case. There is therefore a need for both types of blade and the clinician will choose the most appropriate blade for the situation. 15 The laryngoscope (1) further comprises means for viewing the laryngeal inlet of a patient. Such means can comprise a display screen (not shown) to visualise the area captured, for example, by a camera. A detachable or fixed display screen may be connected at the proximal end of the handle (2) or a separate display screen may be provided. An advantage of having a 20 detachable screen is that the equipment can be easily cleaned after use. Preferably, the viewing means includes at least one camera element (9) which may be located at the distal end of the blade holding element (3) so as to be directed towards the distal end of 9 the blade (4). The image captured by the camera may be transferred to a display screen and/or other viewing means for example by means of fibre optic. The laryngoscope (1) may also comprise a light source and/or any other visualisation means 5 that enable external indirect visualisation of the laryngeal inlet. For example, a light source may be provided so that the distal tip of the blade is illuminated. In operation, the laryngoscope (1) is inserted into the mouth of the patient. The blade (4) will push the tongue of the patient to the side of the oropharynx to create space through which the 10 larynx and the epiglottis can be viewed. The blade (4) is manipulated to lift the epiglottis thereby exposing the laryngeal inlet. An endotracheal tube can then be introduced and advanced past the vocal cords into the trachea. The endotracheal tube can be inserted together with the laryngoscope so that the tube 15 laryngoscope are inserted and positioned at the same time. Alternatively, the laryngoscope may be inserted first and the tube may be inserted after the laryngoscope is in the correct position. The user can visualise the distal end of the blade (4) for example on the display screen and manipulate the laryngoscope (1) accordingly. Once the tube is correctly positioned, the laryngoscope (I) is removed. 20 The main problem solved by the present invention is the adjustment of the viewing field so that the clinician has a clear view of the laryngeal inlet of the patient, with minimum distortion and maximum focus, regardless of the type of blade fitted onto the blade holding element. Preferably, the viewing field covers at least a 30* viewing angle below the tip of the 10 extension (7) for optimum view of the laryngeal inlet. This area cannot be clearly viewed for example when a prior art laryngoscope configured for use with a standard blade is used with a difficult blade, because the view is obstructed by the tracheal tube guiding means and/or because of the ventral displacement of the distal extension of the blade. 5 Embodiment 1 Figure 3 shows part of a laryngoscope according to a first embodiment of the invention, in which the outer contour of the blade holding element (3) corresponds substantially to the 10 inner shape of the sleeves (5a, Sb) of the standard and difficult blades (4a, 4b) so that the blades can be used interchangeably with the same laryngoscope. The fixed camera element (9) is located at the distal end of the blade holding element (3). In figures 4a and Sa, the blade holding element (3) is fitted with a short standard curved blade 15 and with a long standard curved blade (4a), respectively. Line H.-H passes between the centre of the lens of the camera (9) and the pivotal joint between the handle (2) and the blade holding element (3). The camera (9) is arranged so that the centre of the visual field captured by the camera is located at an angle a, ranging for example from 5" to 15" from line H-H in the plan defined by line H-H and the longitudinal axis of the handle (2). In figures 4a and 5a, 20 the exemplary angle is 12.754 and there is minimum blade intrusion into the view frame. The views captured by the camera (9) are shown in figures 4b and 5b. The views are clear and not distorted (as illustrated by the perfectly square grid). These are satisfactory views but I1 ideally the tip of the distal extension (7a) should be visible so that the view is precisely focused on the laryngeal inlet of the patient. In figure 6a, the blade holding element (3) is fitted with a difficult blade (4b). The distal end 5 of the sleeve (6b) comprises a wedge prism that redirects the optical pathway so that the tip of the extension (7b), and therefore the laryngeal inlet of the patient, is visible as shown in figure 6b. Preferably, the prism is chosen so that the centre of the visual field captured by the camera is located for example at an angle ranging from 20* to 400. In figure 6b, the exemplary strength of the prism is 29* which provides an exemplary angle of 35.750 (corresponding to 10 the original angle at of 12.75* plus a ventral tilt 0 1i of 230). However, the view captured by the camera (9) is slightly distorted as can be seen by the compressed grid lines on figure 6b. In this first embodiment, the laryngoscope can be used with interchangeable blades. When fitted with a standard curved blade, no prism is required since a satisfactory view is obtained 15 using a strategic positioning of the camera. For difficult intubations, the clinician replaces the standard curved blade with a difficult blade fitted with a prism as described above to adjust the view so that a clear, non-distorted view of the laryngeal inlet is obtained. Embodiment 2 20 Figure 7 shows part of a laryngoscope according to a second embodiment of the invention. The main difference with the laryngoscope of figure 3 lies in the position of the camera (9). The camera (9) is arranged so that the centre of the visual field captured by the camera is located at an angle a2 ranging for example from 150 to 250 ftom line H-H in the plan defined 12 by line H-H and the longitudinal axis of the handle (2). The angle a2 is greater than ai (for example 170) In figures 8a and 9a, the blade holding element (3) is fitted with a short standard curved blade 5 and with a long standard curved blade (4a), respectively. The views captured by the camera (9) are shown in figures 8b and 9b and include the tip of the extension (7a). The views are clear and not distorted (as illustrated by the perfectly square grid). These are satisfactory views that, when positioned in the patient, precisely focus on the laryngeal inlet of the patient. 10 In figure 10a, the blade holding element (3) is fitted with a difficult blade (4b). The distal end of the sleeve (6b) comprises a wedge prism that redirects the optical pathway so that the tip of the extension (7b) is visible as shown in figure lOb. Preferably, the prism is chosen so that the centre of the visual field captured by the camera is located for example at an angle ranging from 30* to 45*. In figure 6b, the exemplary strength of the prism is 250 which provides an 15 exemplary angle of 370 (corresponding to the original angle a2 of 170 plus a ventral tilt P2 of 20*). The view captured by the camera (9) is less distorted and clearer than that obtained with the stronger wedge prism of the first embodiment (see figure 6b). Embodiment 3 20 Figure 11 shows part of a laryngoscope according to a third embodiment of the invention. The camera (9) is arranged so that the centre of the visual field captured by the camera is located at an angle a 3 ranging for example from 250 to 40 from line H-H in the plan defined by line 13 H-H and the longitudinal axis of the handle (2). The angle a 3 is greater than at and a 2 (for example 320). In figures 12a and 13a, the blade holding element (3) is fitted with a short standard curved 5 blade and with a long standard curved blade (4a), respectively. In addition, a wedge prism is fitted at the distal end of the sleeve (6a) to direct the viewing field towards the tip of the extension (7a). Figures 12b and 13b show the views obtained using the blades of figures 12a and 13a and the 10 re-positioning of the camera on its own (ie. without a wedge prism). No distortion is observed and the view is clear. However, the extension (7a) intrudes into (approximately 1/3 of) the viewing field. By contrast, when a wedge prism is fitted onto the blade (see figures 12c and 13c), the tip of 15 the extension is visible but does not substantially intrude into the viewing field. A slight distortion is observed but the view is sufficiently clear to allow inspection of the patient's airway to efficiently insert a tracheal tube. In figures 12a and 13a, the exemplary strength of the prism is 200 which provides an exemplary angle of 180 corresponding to the original angle u 3 of 320 minus a dorsal tilt P3 of 140. In this case, the tilt P3 is subtracted from the original 20 angle a 3 because the wedge prism is positioned so that the view is re-adjusted dorsally and not ventrally (as in the previous embodiments). In figure 14a, the blade holding element (3) is fitted with a difficult blade (4b). The exemplary strength of the prism is 20* which provides an exemplary angle of 460 corresponding to the 14 original angle U3 of 320 due to the positioning of the camera, plus a ventral tilt P3 of 14* due to the presence of the prism. A clear view with significantly reduced distortion is obtained as can be seen in figure 14c. 5 As a comparison, figure 14b shows a view obtained using the blade of figures 14a and the re positioning of the camera on its own (i.e. without a wedge prism). No distortion is observed and the view is clear but the tip of the extension (7b) is not visible, i.e. the view is not precisely focused on the laryngeal inlet of the patient. 10 Embodiment 4 The laryngoscope of figure 15 is similar to that shown in figure 11. The difference is that the camera (9) is arranged so that the centre of the visual field captured by the camera is located at an angle a 4 of for example 27.50 from line H-H in the plan defined by line H-H and the 15 longitudinal axis of the handle (2). In figures 16a and 17a, the blade holding element (3) is fitted with a short standard curved blade and with a long standard curved blade (4a), respectively. The wedge prism is weaker than that used in embodiment 3, for example with a strength of 16' and the resulting angle is 20 18* corresponding to the original angle a4 of 27.5* due to the positioning of the camera, minus a dorsal tilt P4 of 9.5' due to the presence of the prism. As can be seen on figures 16b and 17b, the extension (7a) intrudes into the viewing field when the blade (4a) is not fitted with a wedge prism, but the view is clear and non-distorted.

15 When the prism is fitted to the distal end of the sleeve (5a) of the blade (4a), then only the tip of the extension (7a) is visible, thereby indicating that a focused view of the laryngeal inlet can be obtained (see figures 16c and 17c). There is little distortion and the view is clear. 5 In figure 18a, the blade holding element (3) is fitted with a difficult blade (4b). The exemplary strength of the prism is 21.5* which provides an exemplary angle of 45" corresponding to the original angle a4 of 27.5* due to the positioning of the camera, plus a ventral tilt P4 of 17.50 due to the presence of the prism. A clear view with significantly reduced distortion is obtained as can be seen in figure 18c. 10 As a comparison, figure 18b shows a view obtained using the blade of figures 18a and the re positioning of the camera on its own (i.e. without a wedge prism). No distortion is observed and the view is clear but the tip of the extension (7b) is not visible. 15 Embodiment 5 The distal end of the blade holding element (3) may be fitted with at least a first and a second camera (9). The first camera may be positioned so that a clear, non-distorted view of the laryngeal inlet is obtained when using a standard blade and the second camera may be 20 positioned so that a clear, non-distorted view of the laryngeal inlet is obtained when using a difficult blade. A laryngoscope fitted with such a viewing means enables the clinician to use one laryngoscope for at least standard and difficult blades, thereby limiting expenses. In addition, this type of laryngoscope may be used with blades which do not require a prism or 16 any other means of adjusting the viewing field, since the viewing field is already adjusted using a multi-camera system. The laryngoscope (1) may further comprise means (for example electronic means) for 5 switching from one camera to the other so that the clinician may select to use the first and/or the second camera depending on the view required and the type of blade fitted onto the blade holding element. 10 Embodiment 6 The inventors further developed the laryngoscope of Embodiment 5 by replacing the multi camera system with a single movable or "tiltable" camera (9) fitted at the distal end of the blade holding element (3). For example, the camera may be encased in a low friction housing, 15 it may be fitted with af mechanical or electronic means of tilting the camera so that the viewing field is focused on the laryngeal inlet of the patient. This type of laryngoscope may be used with blades which do not require any prism or any other means of adjusting the viewing field. 20 The laryngoscope (1) may further comprise means for positioning the camera in the desired position so that a clear, non-distorted view of the laryngeal inlet. For example, the laryngoscope may comprise mechanical or electronic means for remotely changing the position of the camera. Alternatively, the blades may be such that the position of the camera is automatically adjusted when the blade is fitted onto the blade holding element. For example, 25 the distal end (6) of the sleeve (5) may be built or moulded at an angle so that upon fitting the 17 blade onto the blade holding element, the distal end or window (6) pushes the camera into a position suitable for viewing the tip of the extension (7) of the blade in a clear and non distorted manner. Such constructions are shown in figures 20a, 21a and 22a and the corresponding views are shown in figures 20b, 21b and 22b, 5 Where the blade comprises a wedge prism, the prism may be Fitted onto the blade by any suitable means, including for example screws and/or glue. Preferably, the prism is integrally moulded at the distal end of the sleeve. An integrally mounted prism has the advantage of being less expensive, more robust and less prone to contamination. 10 It is believed that currently more than 95% of all intubations can be carried out using a standard blade, which means that clinicians need to buy a laryngoscope, specifically designed for use with a difficult blade, for the remaining 5% (or less) of the intubations. The laryngoscope described above enables clinicians to minimise expenses because only one 15 universal laryngoscope is required for use with physically and functionally dissimilar blades. In addition, the different types of blade may be used interchangeably without substantially compromising the clarity of the view of the patient's laryngeal inlet.

Claims (20)

1. A laryngoscope comprising: a handle, an elongate blade holding element, attached to the handle, wherein the blade 5 holding element comprises a viewing means, and wherein the laryngoscope further comprises at least two different detachable blades, wherein the at least two different detachable blade are slidable relative to the blade holding element, wherein at least one of the blades is for difficult intubations, wherein the blade for difficult intubations comprises a distal extension, wherein the 10 blade for difficult intubations further comprising means for altering the field of view of the viewing means, wherein the means for altering the field of view adjusts the field of view such that the tip of the distal extension is visible.

2. The laryngoscope according to claim 1, wherein the blade comprises a sleeve 15 portion and a distal extension.

3. The laryngoscope according to claim 2, wherein the detachable blade further comprises means for guiding an endotracheal tube towards the tip of the distal extension. 20

4. The laryngoscope according to any one of the preceding claims, wherein the viewing means comprises at least one fixed camera located at the distal end of the blade holding element. 19

5. The laryngoscope according to claim 4, wherein the means for adjusting the viewing field comprises a light refracting means. 5

6. The laryngoscope according to claim 5, wherein the light refracting means comprises a prism or a wedge prism.

7. The laryngoscope according to any one of claims I to 4, wherein the viewing means comprises at least two fixed cameras elements directed to at least two 10 different viewing fields.

8. The laryngoscope according to claim 7, further comprising means for switching from one camera to the other. 15

9. The laryngoscope according to any one of claims 1 to 3, wherein the viewing means comprises a movable camera element.

10. The laryngoscope according to claim 9, further comprising mechanical or electronic means for controlling the movement of the camera. 20

11. The laryngoscope according to claim 9, wherein the distal end of the sleeve of the blade comprises a window positioned such that, in use, the camera is positioned to visualise the laryngeal inlet of the patient. 25

12. A laryngoscope substantially as described herein with reference to the accompanying drawings. 20

13. A blade for a laryngoscope substantially as described herein with reference to the accompanying drawings. 5

14. A handle for a laryngoscope substantially as described herein with reference to the accompanying drawings.

15. A blade holding element for a laryngoscope substantially as described herein with reference to the accompanying drawings. 10

16. A blade holding element for a laryngoscope substantially as described herein with reference to the accompanying drawings.

17. A method for viewing the laryngeal inlet of a patient using the laryngoscope 15 according to any one of claims 1 to 12, the method comprising assessing a patient, determining the correct blade to view the laryngeal inlet of the patient, fitting the blade selected in order to achieve the required viewing angle.

18. The method according to claim 16, wherein the viewing means of the 20 laryngoscope comprises at least one camera element and the blade comprises a light refracting means capable of redirecting the optical pathway of the camera.

19. The method according to claim 16, wherein the viewing means of the laryngoscope comprises at least two camera elements and the viewing field is 25 adjusted by switching the view from one camera to the other. 21

20. The method according to claim 16, wherein the viewing means of the laryngoscope comprises at least one camera element and the viewing field is adjusted by moving the camera.