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Choosing a laryngoscope blade: straight vs curved

London, UK

To the Editor:

Whilst we are impressed that Arino et al.¹ recruited and randomized 500 subjects for a study comparing direct laryngoscopy using five different laryngoscopes by a single operator, we question their conclusion that the Macintosh blade should be preferred to the Miller blade.

Instead, the study data suggest that in those predicted to be a difficult intubation, the Miller blade would offer the best chance of successfully intubating the trachea, although in those predicted to be straightforward, the Macintosh would be the preferred blade.

The vast majority of patients present no airway difficulties and clearly, in these patients, we must all endeavour to avoid the complications associated with intubation. However, like Arino, we recognize that intubating the trachea is the ultimate end-point for determining the efficacy of a laryngoscope blade. In those predicted to be difficult, this must be the over-riding consideration.

The data presented show that when a Miller blade was used, no patient had a grade 3 or 4 laryngoscopic view, whereas eight out of 100 patients had a grade 3 or 4 laryngoscopic view when using a Macintosh blade. In fact, one of the four patients who could not be intubated was in the Macintosh group.

Finally, when applying any conclusions from this study to our own practice, it is noteworthy that a very high success rate for intubation was achieved for all five blades. However, the over-riding factor in the choice of any airway device should be the operator’s past experience and familiarity with the equipment.

Reference

1 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 Anesth 2003; 50: 501–6.[Abstract/Free Full Text]

Related articles in CJA:

REPLY

Jose J. Arino, Jose M. Velasco, Carmen Gasco, and Francisco Lopez-Timoneda
CJA 2003 50: 1079. [Full Text]  

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				R. Mahajan and R. Gupta REPLY Can J Anesth, February 1, 2005; 52(2): 212 - 212. [Full Text] [PDF]

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