Research Article

A Comparative Crossover Randomized Study of Miller and Macintosh Blade for Laryngoscopic View and Ease of Intubating Conditions in Adults

Abstract

Background: Although several types of laryngoscope blades of different sizes and shapes are present, Miller (MIL) blade is the most preferable blade among paediatric population. However, there is dearth in the literature regarding the use of these blades in the adult population. This study aimed to compare the laryngoscopic view and ease of intubation using MIL and Macintosh (MAC) blade among adults.
Methods: A total of 172 patients who were >18 years age, with ASA grades I and II, undergoing elective surgeries with general anaesthesia were included. Patients were distributed in two groups (MAC/MIL and MIL/MAC), where laryngoscopy was first done with MAC blade, followed by MIL blade in the MAC/MIL group and vice-versa in the MIL/MAC group. Grading of laryngoscopic views, number of attempts, ease of intubation and use of backward, upward, rightward pressure (BURP) were noted. R v 3.6.0 was used for statistical analysis and P values≤0.05 were considered as statistically significant.
Results: MIL blade showed better laryngoscopic view compared to MAC blade (32.6% vs. 15.1%; P< 0.002). BURP application helped improve the laryngoscopic views with MAC blade. Intubation with MIL blade was easier with regards to ease of intubation and number of attempts 19 (P value<0.05).
Conclusion: Glottis visualization is better with the MIL blade as compared to the MAC blade. Therefore, the MIL blade might be helpful in securing the airway among adult patients.

[1] Pieters BM, Eindhoven GB, Acott C, Van Zundert AA. Pioneers of laryngoscopy: indirect, direct and video laryngoscopy. Anaesth Intensive Care. 2015; 43(1):4-11.
[2] Varghese E, Kundu R. Does the Miller blade truly provide a better laryngoscopic view and intubating conditions than the Macintosh blade in small children? Pediatr Anesthesia. 2014; 24(8):825-9.
[3] Akbar SH, Ooi JS. Comparison between C-MAC video-laryngoscope and Macintosh direct laryngoscope during cervical spine immobilization. Middle East J Anaesthesiol. 2015; 23(1):43-50.
[4] Lavery GG, Jamison CA. Airway Management in the Critically Ill Adult. Crit Care Med. 2008; 17-37.
[5] Burkle CM, Zepeda FA, Bacon DR, Rose SH. A historical perspective on use of the laryngoscope as a tool in anesthesiology. Anesthesiology. 2004; 100(4):1003-1006.
[6] Arino JJ, Velasco JM, Gasco C, Lopez-Timoneda F. Straight blades improve visualization of the larynx while curved blades increase ease of intubation: a comparison of the Macintosh, Miller, McCoy, Belscope and Lee-Fiberview blades. Can J Anaesth. 2003; 50(5):501-506.
[7] Kulkarni AP, Tirmanwar AS. Comparison of glottic visualisation and ease of intubation with different laryngoscope blades. Indian J Anaesth. 2013; 57(2):170-4.
[8] Yentis SM, Lee DJ. Evaluation of an improved scoring system for the grading of direct laryngoscopy. Anaesthesia. 1998; 53(11):1041-4.
[9] Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987; 42(5):487-90.
[10] Rudraraju P, Eisen LA. Analytic review: confirmation of endotracheal tube position: a narrative review. J Intensive Care Med. 2009; 24(5):283-92.
[11] Wojewodzka-Zelezniakowicz M, Madziala A, Madziala M. Comparison of the Miller and Macintosh laryngoscopes in simulated pediatric trauma patient: a pilot study. Disaster and Emergency Medicine Journal. 2017; 2:1-6.
[12] Garhwal AM, Bhure AR, Bhargava SV, Marodkar KS, Jain AR, Nandwani HP, et al. A clinical assessment of Macintosh blade, Miller blade and King visiontm videolaryngoscope for laryngeal exposure and difficulty in endotracheal intubation. J Evid Based Med Healthc. 2016; 3:1380-1385.
[13] Benumof JL, Cooper SD. Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation. J Clin Anesth. 1996; 8(2):136-140.
[14] Achen B, Terblanche OC, Finucane BT. View of the larynx obtained using the Miller blade and paraglossal approach, compared to that with the Macintosh blade. Anaesth Intensive Care. 2008; 36(5):717-21.
[15] Marks RR, Hancock R, Charters P. An analysis of laryngoscope blade shape and design: new criteria for laryngoscope evaluation. Can J Anaesth. 1993; 40(3):262-270.
[16] Baliarsing L, Gore M, Akulwar P. Comparison of Glottis View and Hemodynamic Response by using Macintosh and MacCoy Laryngoscopes for Endotracheal Intubation in General Anaesthesia for Elective Surgery. International J Contemporary Medical Research. 2016; 3:2186-2188.
[17] Nishiyama T, Higashizawa T, Bito H, Konishi A, Sakai T. Which laryngoscope is the most stressful in laryngoscopy; Macintosh, Miller, or McCoy? Masui 1997; 46(11):1519-24.
Files
IssueVol 7 No 2 (2021): Spring QRcode
SectionResearch Article(s)
Published2021-05-31
DOI https://doi.org/10.18502/aacc.v7i2.6288
Keywords
Anaesthesia Hemodynamic Laryngoscopy Random allocation Adults

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Nalini K, Gopal A, Iyer S, Mungasuvalli N. A Comparative Crossover Randomized Study of Miller and Macintosh Blade for Laryngoscopic View and Ease of Intubating Conditions in Adults. Arch Anesth & Crit Care. 7(2):58-2.