[A modified Macintosh blade for difficult intubation. The mirror blade]

Area of Science:

• Anesthesiology
• Medical Device Innovation
• Airway Management

Context:

• Difficult intubations pose significant risks during anesthesia, often due to anatomical variations.
• Conventional laryngoscopes can present limitations, leading to unexpected challenges in visualizing the larynx.
• Existing adjuncts for difficult intubation have varying degrees of effectiveness and complexity.

Purpose:

• To evaluate a modified Macintosh laryngoscope blade with an integrated mirror for orotracheal intubation.
• To compare the efficacy of direct versus mirror-assisted visualization for laryngeal access.
• To assess the utility of the device in managing predicted and unpredicted difficult airways.

Summary:

• A size 3 Macintosh blade was modified with a tangential mirror, allowing simultaneous direct and indirect laryngeal viewing.
• In 20 patients undergoing procedures requiring intubation, the mirror-assisted technique was compared to conventional laryngoscopy.
• The mirror provided better laryngeal visualization in 15 patients, facilitating intubation with a guide-wire, especially in cases of Cormack and Lehane grades 3 and 4 difficulty.

Impact:

• The mirror-blade laryngoscope offers a dual visualization approach, proving effective for unexpected difficult intubations.
• Its use may reduce the effort required for laryngeal exposure and simplify the intubation process.
• The device is suitable for training and can be integrated into 'failed intubation' protocols for anesthesia personnel.