Tuesday January 16, 2007

Q: What is the advantage of Miller blade over "Mac" blade ?

A: Traditionally, Macintosh remained choice of blade while intubating patient as the curvature of the blade allows the tip to fall naturally into position in the vallecula of the patient and the wide flange assists in holding the tongue safely aside during intubation. But in situation where vocal cords are not easily visible or in coagulopathic patients where concern of trauma and bleed is high Miller blade may provide some advantage. The narrower flange is designed to reduce trauma and the curved tip facilitates easy anterior lifting of the epiglottis. This allow greater exposure of the larynx.

It is a good practice to keep Miller blade as a backup with Mac if vocal cord is hard to reach or hard to see even after appropriate alignment of 3 axes.

(A= before adjusting neck, B= after adjusting neck).