A randomised comparison of three laryngoscopes with the Macintosh

Maleck, Wolfgang H.; Koetter, Katharina P.; Lenz, Martina; Piper, Swen N.; Triem, J. G.; Boldt, Joachim

doi:10.1016/s0300-9572(99)00094-5

Cited by 9 publications

(3 citation statements)

References 18 publications

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“…In accordance with other studies 9,[11][12][13][14] the distance between flange and teeth was increased significantly, while the visibility of laryngeal structures was improved in comparison to the original Macintosh blade. According to Lockhart et al, 15 51% of dental traumas in anesthesiology occur during tracheal intubation by contact of the laryngoscope's flange with the maxillary left incisor.…”

Section: Discussionsupporting

confidence: 91%

Lower flange modification improves performance of the Macintosh, but not the Miller laryngoscope blade

Kimberger

Fischer

Plank

et al. 2006

Can J Anesth/J Can Anesth

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Purpose:In order to minimize the potential for dental damage and to improve laryngeal visualization during tracheal intubation, two commonly used laryngoscope blades were modified and compared in a clinical setting: the Miller laryngoscope blade and the Macintosh laryngoscope blade. Modified versions of both laryngoscope blades with a lowered heel (Callander modification) at the proximal end of the blade were compared to standard blades. Methods:Forty patients scheduled for general anesthesia requiring endotracheal intubation were studied prospectively. Preoperatively, the patients' airways were evaluated according to Mallampati score, thyromental distance and interincisor gap. After induction of anesthesia laryngoscopy was performed with the original laryngoscope and its modified counterpart in random order. A lateral x-ray of the neck was taken after the optimal view had been obtained, and blade-tooth distance, laryngeal view, blade-tooth contact and need for assistance were measured. Using angular calculations the laryngoscopes were analyzed at different insertion depths on graph paper, and the results were compared with data from the lateral x-rays.Results: With a modified Macintosh blade the blade-tooth distance was significantly greater in comparison to the original design (2.5 ± 2.1 cm vs 0.2 ± 0.1 cm, P < 0.01). Consequently the number of blade-tooth contacts was significantly lower (20% vs 75%, P < 0.05). The best laryngeal view could be obtained using a modified Macintosh laryngoscope. With a modified Miller laryngoscope laryngeal visibility was not improved and assistance was required more often to achieve adequate intubating conditions (35% vs 5%, P < 0.05). Conclusion:A reduction of the proximal flange of a Miller blade decreases the blade's effectiveness for laryngeal visualization, whereas a similar modification of a Macintosh blade increases blade-tooth distance, decreases the number of bladetooth contacts and provides a better laryngeal view. Objectif

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Section: Discussionsupporting

confidence: 91%

Lower flange modification improves performance of the Macintosh, but not the Miller laryngoscope blade

Kimberger

Fischer

Plank

et al. 2006

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…The authors described bending it through a range from 15 to 45 degrees, with optimal position thought to be 35 degrees from the horizontal for indirect lifting of the epiglottis (Fig. 112 As a group, these blades may have utility in patients with limitations of mouth opening, impaired head and neck mobility, or prominent upper incisors, in whom the tip of a Macintosh blade may otherwise fail to engage the glossoepiglottic fold at the appropriate angle. 63 Found to be effective in some cases in which Macintosh laryngoscopy had failed, the blade may have been the forerunner of other blades with a marked fixed or variable distal curvature.…”

Section: Curved Blades With Exaggerated Distal Curvaturementioning

confidence: 99%

“…The blade is curved in similar fashion to the Macintosh blade and simply omits the vertical step with the exception of a minimal amount midblade, where needed to protect the light carrier ( Fig. 112 The blade may be useful in certain difficult situations but requires further study. The inventors' experience in several hundred patients was one of "complete satisfaction," particularly in patients with "buck" teeth, receding jaw, "bull neck," and anterior larynx.…”

Section: A Bizzarri-giuffrida Bladementioning

confidence: 99%