2018 FSA Posters

P027: MAC AS A MILLER: A NONTRADITIONAL RESCUE MANEUVER FOR THE OBSTRUCTING EPIGLOTTIS
David M Corda, MD; University of Florida College of Medicine

Background:  Traditional airway education typically includes instruction on use of both the Miller and Macintosh laryngoscope blades.  Conventional techniques include lifting the epiglottis with the Miller blade and lifting in the valecula with the Macintosh blade. 

Case Reports:  We present multiple cases of both direct larygoscopy and indirect video laryngoscopy where view of the glottic opening was obstructed by an olongated or omega-shaped epiglottis despite correct positioning and usage of a Macintosh laryngoscope blade.  By utilizing the Macintosh laryngoscope blade non traditionally as a Miller blade, the view was improved from a Cormack-Lehane(CL) grade 3 view to a CL grade 1 view leading to successful endotracheal intubation. 

Discussion:  Although this maneuver (using a Macintosh blade like a Miller blade) may seem commonplace to a few, many anesthesiologists fail to recognize its usefulness. Furthermore, an informal survey amongst providers encountering the same scenario revealed that most would change blades and re-instrument the airway or use blind passage of a bougie to assist intubation.  Although those techniques may help, they may cause unwanted airway trauma.