To the Editor:-We will describe a previously unreported complication involving the use of the Bullard laryngoscope.

Some versions of the Bullard laryngoscope come with a separate, attachable plastic blade-extender intended to facilitate use in the larger male patient. We have recently observed two cases in which the plastic blade-extender became dislodged into the patient's hypopharynx. Both cases involved resident physicians who had limited experience with the Bullard laryngoscope. In both cases, the loss of the blade-extender was recognized immediately, and a direct laryngoscope and McGill forceps were used to retrieve the blade-extender from the patient's hypopharynx. Neither patient suffered significant morbidity.

The blade-extender snaps onto the Bullard blade with a distinct click and requires moderate force to place into proper position. Individuals unfamiliar with the blade-extender can slide it unto the blade without actually snapping it into place. The Bullard can be used successfully with the blade-extender in such an “incorrect” position. Figure 1illustrates proper and improper placement of the blade-extender. Improper proper placement with subsequent displacement probably accounts for the two cases that are reported here.

This report emphasizes the importance of proper training for safe use of the Bullard laryngoscope and the need for vigilance when using the blade-extender.

Kenneth A. Marshall, M.D.

Senior Consultant; Department of Anesthesiology

Christopher F. James, M.D.

Senior Associate Consultant; Department of Anesthesiology; Mayo Clinic Jacksonville; Jacksonville, Florida;

(Accepted for publication July 13, 1998.)