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Canadian Journal of Anesthesia 50:1079 (2003)
© Canadian Anesthesiologists' Society, 2003

Correspondence

REPLY

Jose J. Arino, MD PhD, Jose M. Velasco, MD, Carmen Gasco, MD PhD and Francisco Lopez-Timoneda, MD PhD

Madrid, Spain

We consider that straight blades improve visualization of the larynx while curved blades increase ease of intubation. A good laryngeal view with the intubating device did not equal ease of intubation. Since the most important aspect of any laryngoscopic intubation is the correct placement of the endotracheal tube, and not the visualization of the larynx, we recommend the use of a curved blade to improve the ease of intubation. Curved blades provide more room in the oropharynx to maneuver the endotracheal tube, even if the laryngeal view is Cormack grade 3.1

When laryngoscopy is difficult with the curved blade (the epiglottis obstructs the view of the larynx) the use of a straight blade may help to achieve adequate laryngeal visualization,2 but the ease of intubation may not improve. Like Marks et al.3 we recognize that the curved tip of the Miller blade offers better intubating conditions than other straight blades.

We agree that the operator's experience and familiarity is an important factor in the choice of any airway device.

References

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]

2 Benumof JL. Difficult laryngoscopy: obtaining the best view. Can J Anaesth 1994; 41: 361–5.[Free Full Text]

3 Marks RR, Hancock R, Charters P. An analysis of laryngoscope blade shape and design: new criteria for laryngoscope evaluation. Can J Anaesth 1993; 40: 262–70.[Abstract]


Related articles in CJA:

Choosing a laryngoscope blade: straight vs curved
Michael Lim, Charlotte Demspey, and Michael Pead
CJA 2003 50: 1078-1079. [Full Text]  




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