Successful difficult airway intubation using the Miller laryngoscope blade and paraglossal technique – a comparison with the Macintosh blade and midline technique

Abstract

In anaesthetic practice clinicians are often faced with di cult airway situations. The conventional approach to intubation is the midline technique using a curved Macintosh blade for direct laryngoscopy. However, we have been successful in such a case using old technology and a seldom-used technique. This case raised the question whether older, alternative, methods of tracheal intubation may o er an advantage in airway management above the conventional practice. During pre-operative evaluation a patient presented with a large visible epiglottis on evaluation of the mouth and oropharynx. On direct laryngoscopy with a Macintosh 3 laryngoscope blade and the midline technique, a Cormack and Lehane grade-3b view was obtained due to the long epiglottis but normal position of the larynx. The Miller 4 blade and the paraglossal technique yielded a Cormack and Lehane grade-1 view and the trachea was successfully intubated using this approach. Use of the Miller blade and the paraglossal technique provided a perfect view of the glottis. Based on this experience and the findings of several studies on this topic, this approach could be a viable alternative to airway management.

Keywords: difficult airway, Miller blade, Mallampati 0, Macintosh technique, paraglossal technique