Laryngoscope blades Mac vs. Miller

Laryngoscope blades are typically used as the primary tool for the examination of the interior of the airway and for placement of an endotracheal tube. Choosing the correct size laryngoscope blade

is critical to successful endotracheal intubation.

 

 

 

 

 

 

 

 

 

 

 

 

Mac

In 1943, Macintosh introduced the curved laryngoscope blade. At this time, the blade was utilized for the intubation of older children whose anatomy resembles that of an adult.  In 1947, modifications were implemented to the original blade to better suit the pediatric population. The Macintosh laryngoscope blade is popular even for small children. This blade is the predominate model of all the curve blades. The Mac blade is designed to lift the epiglottis indirectly and provide a view of the larynx by placing the tip of the blade in the vallecula. In infants and young children who have a floppy epiglottis, the Mac blade may not provide adequate exposure of the larynx.

• Less traumatic

• Less of a view

• Less stimulating (less tachycardia and/or arrythmias)

• Favored in patients with BIG TONGUES

• Lifts the epiglottis INDIRECTLY

 

 

Miller

In 1946, Miller described a modification of the original adult laryngoscope, introducing a pediatric laryngoscope blade. The blade could be inserted either anterior or posteriorly to the epiglottis. Today, the Miller blade is one of the most popular laryngoscopes for pediatrics and difficult-to-intubate patients. Many practitioners prefer a straight blade laryngoscope on pediatric patient due to the unique upper airway anatomy of an infant or a small child. A straight blade is favorable in elevating the tongue so it is then removed from the field to facilitate optimal visualization of the infant larynx; however, there is a greater potential to damage the epiglottis with a straight blade, with the direct elevation of the epiglottis itself rather and applying the indirect method.

• More traumatic

• More of a view

• More stimulating

  • The direct contact by the Miller blade on the epiglottis may trigger tachycardia and / or arrythmias.

  • The Superior Laryngeal Nerve (SLN), a branch of the vagus, divides into an external-motor nerve and an internal-sensory nerve that provide sensory innervation to the larynx between the epiglottis and the vocal cords.

• Preffered in neonates/infants, pediatrics, and patients with LONG, FLOPPY, and/or ANTERIOR Epiglottis

• Lifts the Epiglottis DIRECTLY