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An Inquiry on Airway Management by McCoy Blade with Elevated Tip and Miller Straight Blade with Paraglossal
Sri Vidhya1, Neel Prakash2, Amlan Swain1
1Department of Anaesthesiology, Tata Main Hospital, Jamshedpur, Jharkhand, India.
Background:
Modifications of curved and straight laryngoscope blades have been used for airway management since a long time. While McCoy blade with an elevated tip is commonly used to intubate patients with anticipated difficult airway, the Miller's straight blade is used for intubations in children and less commonly adults. In this study, we revisit the paraglossal technique of Miller's straight blade as a method to improve laryngeal view especially in difficult intubations.
Aim:
This study aimed to compare laryngoscopic view and ease of intubation (EOI) using McCoy blade elevated tip and Miller's straight blade paraglossal technique.
Materials And Methods:
A prospective single-blind study was conducted on 170 patients undergoing elective surgery under general anesthesia. They were randomly allotted to two groups. In Group A, laryngoscopy was performed by Miller's blade paraglossal approach, whereas in Group B, laryngoscopy was performed by McCoy blade with an elevated tip. Laryngeal view was graded using the modified Cormack-Lehane grading, and EOI was graded using EOI score. These were compared with preoperative intubation prediction score. Statistical analysis was done using "Medcalc" version 19.0.3. Numerical and categorical data were analyzed by Student's t-test and Chi-square test, respectively. A P < 0.05 was considered statistically significant.
Results:
The paraglossal approach with Miller's blade offered better laryngoscopic view as compared with McCoy blade with an elevated tip in normal (54.1% vs. 25.9%) and difficult airway (44.7% vs. 11.8%). Tracheal intubation was easier with McCoy blade with an elevated tip although the success rate of intubation improved with the assistance of a bougie with Miller's straight blade paraglossal approach.
Conclusion:
The laryngeal view was significantly better with the paraglossal approach of Miller's straight blade even in difficult airway. McCoy blade with an elevated tip was also found to be a useful tool to have in difficult airway, as EOI is significantly higher. The study also highlights the usefulness of adjuncts such as a gum elastic bougie while intubating.
Insights
Miller's straight blade paraglossal technique offers a superior laryngeal view compared to the McCoy blade, especially in difficult airways. While the McCoy blade facilitates easier intubation, Miller's blade with a bougie improves overall success rates for airway management.
Area of Science:
- Anesthesiology
- Airway Management
- Medical Devices
Background:
- Laryngoscope blades, including curved (McCoy) and straight (Miller's), are crucial for airway management.
- The McCoy blade is favored for anticipated difficult airways, while Miller's blade is used for pediatric and some adult intubations.
- This study re-evaluates Miller's straight blade paraglossal technique for enhanced laryngeal visualization.
Purpose of the Study:
- To compare the laryngoscopic view and ease of intubation (EOI) between the McCoy blade's elevated tip and Miller's straight blade paraglossal technique.
- To assess the effectiveness of these techniques in both normal and difficult airway scenarios.
Main Methods:
- A prospective, single-blind study involving 170 patients undergoing elective surgery.
- Patients were randomized into two groups: Group A (Miller's blade paraglossal approach) and Group B (McCoy blade with elevated tip).
- Laryngeal view (modified Cormack-Lehane grading) and EOI were assessed and compared with preoperative predictions; statistical analysis used Student's t-test and Chi-square test (P < 0.05 significant).
Main Results:
- Miller's blade paraglossal approach yielded a significantly better laryngeal view in both normal (54.1% vs. 25.9%) and difficult airways (44.7% vs. 11.8%) compared to the McCoy blade.
- Tracheal intubation was easier with the McCoy blade.
- The success rate of intubation improved with Miller's straight blade paraglossal approach when a bougie was used.
Conclusions:
- The Miller's straight blade paraglossal approach provides a superior laryngeal view, even in difficult airways.
- The McCoy blade with an elevated tip is valuable for difficult airways due to significantly higher EOI.
- Adjuncts like the gum elastic bougie are beneficial during intubation procedures.
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