I Love the miller blade - Seeking more mastery

[Status Sciaticus]

I don't use the Miller for two reasons.
1) Why get the metal closer to the cords than you need to? Using a Miller blade increases the likelihood of trauma and edema of the cords. This is especially true in learners who insert the blade too deep to start.
2) MAC intubations look smoother than Miller intubations. After supervising for a year and watching experienced CRNAs readjust the blade multiple times to pick up the epiglottis it became clear that MAC had improved speed and better optics. I rarely have to optimize the positioning with a MAC blade and non-styletted tube curved in a loop.

The whole point is to get the metal closer to the airway, specifically to lift the epiglottis. Unless youre shoving the blade through the vocal cords, there should be no trauma to the area.

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[minwoo]

The Miller became my goto blade during the covid era when everybody would leave the OR during induction/intubation so no help with cricoid pressure to manipulate the cords into view. I'm definitely getting alot more grade 1 views now vs the more frequent grade 2b/3 views I would get previously with a MAC.

 

[dhb]

The Miller became my goto blade during the covid era when everybody would leave the OR during induction/intubation so no help with cricoid pressure to manipulate the cords into view. I'm definitely getting alot more grade 1 views now vs the more frequent grade 2b/3 views I would get previously with a MAC.

Wouldn't that mean that your usual positioning is good for a Miller and not great for a Mac?

 

[minwoo]

Wouldn't that mean that your usual positioning is good for a Miller and not great for a Mac?

Sooo what position is better for a MAC vs Miller? I almost always position the patient so that the shoulders are on the bottom 1/3 of a pillow, allowing the head to go into a natural sniffing position

 

[GassYous]

Sooo what position is better for a MAC vs Miller? I almost always position the patient so that the shoulders are on the bottom 1/3 of a pillow, allowing the head to go into a natural sniffing position

I just stick the blade in and lift with a mac. With a miller I tilt their head back a little before I go in.