#MACINTOSH BLADE SIZES MAC#
Others recommend inserting the MAC blade under the epiglottis and lifting the latter. Furthermore, some have modified the practices recommended by Miller and Macintosh by advocating that the Miller blade may be inserted into the vallecula, pressing on the hyoepiglottic ligament to lift the tongue base 6 to expose the laryngeal inlet. In addition, they maintain that using the MAC blade is less stimulating than the Miller blade since the former is inserted into the vallecula stimulating the glossopharyngeal nerve, whereas the latter lifts the epiglottis from its under surface, stimulating the recurrent laryngeal nerve. Those who advocate Macintosh's approach argue that his blade reliably exposes the laryngeal inlet without traumatizing the under surface of the epiglottis and without the often difficult challenge of lifting the floppy epiglottis in infants. This manoeuvre flips the epiglottis upwards, exposing the laryngeal inlet to facilitate tracheal intubation.
5 He advocated inserting the blunt tip of the MAC blade into the vallecula and depressing the hyoepiglottic ligament. its curve), but because of the technique that he advocated to expose the laryngeal inlet. 1 In contrast, Macintosh 4 advocated his blade for use in children, not so much because of its unique physical characteristics (e.g. 1– 3 The reasons for the blade's popularity include the belief that the Miller blade provides a superior view of the laryngeal inlet, effectively displaces the tongue to the left of the blade, and lifts the long and floppy epiglottis out of view during laryngoscopy. The Miller (straight) laryngoscope blade is regarded as the preferred blade to expose the laryngeal inlet in infants and children during tracheal intubation. Views with the MAC blade were better when placed into the vallecula compared with under the epiglottis. The views with the Miller blade were similar when placed under the epiglottis or into the vallecula. In this study, similar views at laryngoscopy could be obtained with Miller and MAC size 1 blades. There are few data comparing the Miller and Macintosh (MAC) laryngoscope blades in children aged <2 yr.
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