Successful Difficult Airway Intubation Using the Miller Laryngoscope Blade and Paraglossal Technique, May 2015

P Anderson, J Espanaco Valdés, JG Vorster

South African Journal of Anaesthesia and Analgesia, May  2015

Abstract:
In anaesthetic practice clinicians are often faced with difficult 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 offer 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.