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Does the M iller blade truly provide a better laryngoscopic view and intubating conditions than the M acintosh blade in small children?
Author(s) -
Varghese Elsa,
Kundu Ratul
Publication year - 2014
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12394
Subject(s) - medicine , blade (archaeology) , aeronautics , mechanical engineering , engineering
Summary Background Both M iller and M acintosh blades are widely used for laryngoscopy in small children, though the M iller blade is more commonly recommended in pediatric anesthetic literature. The aim of this study was to compare laryngoscopic views and ease and success of intubation with M acintosh and M iller blades in small children under general anesthesia. Materials and Method One hundred and twenty children aged 1–24 months were randomized for laryngoscopy to be performed in a crossover manner with either the M iller or the M acintosh blade first, following induction of anesthesia and neuromuscular blockade. The tips of both the blades were placed at the vallecula. Intubation was performed following the second laryngoscopy. The glottic views with and without external laryngeal maneuver ( ELM ) and ease of intubation were observed. Results Similar glottic views with both blades were observed in 52/120 (43%) children, a better view observed with the M iller blade in 35/120 (29%) children, and with the M acintosh blade in 33/120 (28%). Laryngoscopy was easy in 65/120 (54%) children with both the blades. Restricted laryngoscopy was noted in 55 children: in 27 children with both the blades, 15 with M iller, and 13 with M acintosh blade. Laryngoscopic view improved following ELM with both the blades. Conclusion In children aged 1–24 months, the M iller and the M acintosh blades provide similar laryngoscopic views and intubating conditions. When a restricted view is obtained, a change of blade may provide a better view. Placing the tip of the M iller blade in the vallecula provides satisfactory intubating conditions in this age group.