A do-it-yourself video laryngoscope for endotracheal intubation of COVID-19 positive patient.

Sir,

World Health Organisation has declared coronavirus disease (COVID-19) a pandemic and the number of infected cases in India is increasing daily. Intubation of COVID-19 positive patient is an aerosol-generating medical procedure and increases risk of spread of infection. Anaesthesia provider must wear enhanced personal protective equipment for the procedure and after pre-oxygenation and rapid sequence induction, intubation with video laryngoscopy is preferred as it improves intubation success and increases the distance between the patient's airway and that of the anaesthesiologist who performs the intubation.[1] Video laryngoscope is a highly priced, delicate instrument which is not available in every health facility in India. A simple, do-it-yourself video laryngoscope may be used to intubate COVID-19 positive patient which requires little effort and minimum technical knowledge and expertise.

The video laryngoscope is made by some modification of a Macintosh laryngoscope blade, incorporating a high-resolution image quality (1200p camera with 8 LED light) Wi-Fi borescope [Figure 1] which is available in local electronics market and e-commerce website. An android mobile phone sealed in a thin, transparent, disposable plastic bag is connected with the borescope wirelessly that works as a monitor [Figure 2]. Android application of Wi-Fi borescope is downloaded beforehand as mentioned by borescope manufacturer. The borescope is attached in the groove of the Macintosh blade at 4 cm proximal to the tip by plastic glue [Figure 3]. The battery of the laryngoscope is removed and the Wi-Fi connector part is inserted inside the handle of the laryngoscope [Figure 4]. The handle of the laryngoscope with wiring of the borescope is covered by a round rubber sheath. The borescope can be charged by any android mobile charger. After borescope is powered on, the android mobile Wi-Fi has to be connected to the borescope and the mobile application has to be open. The brightness, color, resolution of the video can be selected in the setting of the mobile application. The laryngoscope can be used same as routine intubation procedure with Macintosh blade. Endotracheal tube of smaller diameter (6.5–7.5 mm) can be passed smoothly when number 4 sized blade is used. The borescope is water proof and produces no electrical hazard to the patient. The tiny LED bulbs produce very little heat that makes the camera tip as warm as body temperature which perhaps creates antifog system that is very much needed. The video laryngoscope should be kept in disposable bag after use and sanitised with ethyl alcohol based disinfectant wipe.

Figure 1

Complete picture of video laryngoscope made with Macintosh blade size 4

Figure 2

Android mobile as monitor that is showing image from half inserted laryngoscope blade in oral cavity

Figure 3

Tip of the laryngoscope with camera

Figure 4

The circuit of the borescope inserted in the battery pocket of the laryngoscope handle

A Wi-Fi videoscope or video borescope typically utilises a charge-coupled device or complementary metal-oxide-semiconductor camera sensor, located at the tip of the borescope, to produce an image that is relayed to an external monitor connected wirelessly.[2] The high-quality display and graphical processing present in android smartphones is utilised keeping the initial and recurring costs of the technique low.[3] The purpose of this technique is to enhance safety and accuracy of intubation procedure when the healthcare provider has to wear PPE with goggles and wants to keep distance from patient's airway. The main drawbacks are that it needs a little bit of practice and proper disinfection is necessary. Such improvised devices may enhance safety of heath care provider in resource poor countries where commercial video laryngoscopes are not easily available in the crisis period.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.