oa Southern African Journal of Anaesthesia and Analgesia - Successful difficult airway intubation using the Miller laryngoscope blade and paraglossal technique - a comparison with the Macintosh blade and midline technique : case report

Volume 21, Issue 2
  • ISSN : 2220-1181
  • E-ISSN: 2220-1173



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 o er 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.

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