MAC vs Miller Blade, hemodynamic response to intubation

[coffeebythelake]

I distinctly remember learning in residency that Miller blade = more significant hemodynamic response due to lifting posterior epiglottis (CN X) vs Mac blade in vallecula (CN IX).

Any references on this? Or am I making things up in my head?

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[San Marzano]

What's a Miller blade?

 

[deleted162650]

😆

 

[Psai]

I learned in residency than macs are for amateurs

 

[deleted875186]

I thought the greatest hemodynamics response was from the ETT hitting the trachea, not suspension from DL.

 

[DM27]

I have trouble believing this was studied in any verifiable manner. I would honestly presume that the difference between the two is equivalent to the difference between being hit by different types of sledgehammers where either scenario is essentially maxing your pain response. Also, I think the greatest physiologic response is indeed from the ETT stimulating the trachea and hopefully not the carina as well.

 

[T-burglar]

The hemodynamic response to intubation is the balance between the thickness of the anesthetic you just pushed and the slickness of the tube you just pushed.

If you struggle to get it in like most Mac blade users the patients usually start to get tachy

 

[jwk]

The hemodynamic response to intubation is the balance between the thickness of the anesthetic you just pushed and the slickness of the tube you just pushed.

If you struggle to get it in like most Mac blade users the patients usually start to get tachy

Anyone can ram an ETT in with a straight blade. It takes skill and finesse and less time to do it with a Mac. 🙂 As I recall, JPP could tube a gravid fire ant with a Mac.

 

[coffeebythelake]

, I think the greatest physiologic response is indeed from the ETT stimulating the trachea and hopefully not the carina as well.

Yes this is verifiably true

 

[anbuitachi]

i was working w an ENT attending one day and she said Miller blades cause more trauma than MAC blades. she said she notice trauma to epiglottis when we use miller blades vs macs, b/c a lot of the times the miller blade is pushing the epiglottis and then its inwards then lifted, instead of just lifting it up. i imagine this occurs more when we get a good view with 1 shot instead of looking at the epiglottis w miller blade and then advancing it and seeing it get lifted

 

[drmwvr]

Of all the (irrelevant) talking points for or against different blades, I'd put sympathetic response near the bottom. Hemodynamic response is a primary reason for our presence in the hospital...who cares? If there is an out of proportion sympathetic response to DL, it sure isn't because of the choice of blade.