Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021;53(3):246-251.
doi: 10.5114/ait.2021.108561.

Glottic views using a Miller size 0 blade are superior to those from a Macintosh size 0 blade in neonates: a randomized trial

Ayten Saracoglu  1 , Jerrold Lerman  2 , Haluk Kafali  3 , Huseyin Canaz  3 , Kemal T Saracoglu  4
Affiliations
Randomized Controlled Trial

Glottic views using a Miller size 0 blade are superior to those from a Macintosh size 0 blade in neonates: a randomized trial

Ayten Saracoglu et al. Anaesthesiol Intensive Ther. 2021.

Abstract

Introduction: Both the Miller and Macintosh blades are commonly used during laryngoscopy in infants and children, although the glottic views have not been compared in neonates. This study compared the glottic views with the Miller and Macintosh size 0 blades in neonates when the blades were placed above and below the epiglottis.

Material and methods: Forty anaesthetized and paralyzed neonates undergoing elective surgery were enrolled and randomized to either the Miller or Macintosh size 0 blade. Two glottic views were obtained in random order in each neonate and were photographed using the same blade: lifting the epiglottis first then the tongue base or vice versa. The percentage of glottic opening (POGO) scores were evaluated with each view. The POGO scores and cardiorespiratory variables were then analysed.

Results: The POGO scores using the Miller blade to lift both the epiglottis and the tongue base were similar, whereas the scores using the Macintosh blade to lift the epiglottis were greater than those to lift the tongue base. The POGO scores using the Miller blade in both positions were significantly greater than those using the Macintosh blade in the corresponding positions (P = 0.0001). The heart rate using the Miller blade was greater than that using the Macintosh blade (P = 0.0001).

Conclusions: In neonates, the glottic views using the Miller size 0 blade to lift both the epiglottis and the tongue base were deemed to be excellent and superior to those using the Macintosh blade in both positions.

Keywords: glottic view.; laryngoscope; laryngoscopy; neonate.

PubMed Disclaimer

Conflict of interest statement

none.

Figures

FIGURE 1
FIGURE 1
A) After optimizing the view of the glottis, the camera was positioned next to the laryngoscope handle of the Miller size 0 laryngoscope blade and focused on the vocal cords. B) After optimizing the view of the glottis, the camera was positioned next to the laryngoscope handle of the Macintosh size 0 laryngoscope blade and focused on the vocal cords
FIGURE 2
FIGURE 2
The POGO scores with the Miller and Macintosh size 0 blades lifting the epiglottis or the tongue base. Summary data are means and 95% confidence intervals. βThe POGO scores lifting the epiglottis with the Macintosh blade were less than those with the Miller blade (unpaired t-test, P = 0.0001). *The POGO scores lifting the tongue base with the Macintosh blade were less than with the Miller blade (unpaired t-test, P = 0.0001). ∂The POGO scores with the Macintosh blade lifting the tongue base were less than those lifting the epiglottis (paired t-test, P = 0.027)
FIGURE 3
FIGURE 3
The heart rate with the Miller and Macintosh size 0 blades preand postlaryngoscopy. Summary data are means and 95% confidence intervals. * The heart rates with the Miller blade postlaryngoscopy were greater than prelaryngoscopy (paired t-test, P = 0.001). βThe heart rates prelaryngoscopy with the Macintosh blade were less than those with the Miller blade (unpaired t-test, P = 0.0001). ∂The heart rates with the Macintosh blade postlaryngoscopy were less than those with the Miller blade postlaryngoscopy (paired t-test, P = 0.0001)
FIGURE 4
FIGURE 4
The mean arterial pressure (MAP) with the Miller and Macintosh size 0 blades lifting the epiglottis or the tongue base. Summary data are means and 95% confidence intervals. *The MAP with the Miller blade postlaryngoscopy was greater than those prelaryngoscopy (paired t-test, P = 0.0001). ∂The MAP postlaryngoscopy with the Macintosh blade was less than that with the Miller blade (unpaired t-test, P = 0.003)
FIGURE 5
FIGURE 5
SpO2 with the Miller and Macintosh size 0 blades lifting the epiglottis or the tongue base. Summary data are means and 95% confidence intervals. Numerals depict the number of neonates at each saturation value. *The SpO2 with the Miller blade postlaryngoscopy was statistically, but not clinically, less than that prelaryngoscopy (paired t-test, P = 0.015). βSpO2 with the Macintosh blade postlaryngoscopy was statistically, but not clinically, less than prelaryngoscopy (paired t-test, P = 0.03)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Davenport HT, Rosales JK. Endotracheal intubation of infants and children. Can Anaesth Soc J 1959; 6: 65-74. doi: 10.1007/BF03014197. - DOI - PubMed
    1. Jones RM, Jones PL, Gildersleve CD, Hall JE, Harding LJ, Chawathe MS. The Cardiff paediatric laryngoscope blade: a comparison with the Miller size 1 and Macintosh size 2 laryngoscope blades. Anaesthesia 2004; 59: 1016-1019. doi: 10.1111/j.1365-2044.2004.03839.x. - DOI - PubMed
    1. Passi Y, Sathyamoorthy M, Lerman J, Heard C, Marino M. Comparison of the laryngoscopy views with the size 1 Miller and Macintosh laryngoscope blades lifting the epiglottis or the base of the tongue in infants and children <2 yr of age. Br J Anaesth 2014; 113: 869-874. doi: 10.1093/bja/aeu228. - DOI - PubMed
    1. Varghese E, Kundu R. Does the Miller blade truly provide a better laryngoscopic view and intubating conditions than the Macintosh blade in small children? Pediatr Anesth 2014; 24: 825-829. doi: 10.1111/pan.12394. - DOI - PubMed
    1. Lingappan K, Arnold JL, Fernandes CJ, Pammi M. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates. Cochrane Database Syst Rev 2018; 6: CD009975. doi: 10.1002/14651858.CD009975.pub3. - DOI - PMC - PubMed

Publication types