Mac vs Miller

[badasshairday]

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What would you guys recommend a doc in another specialty who intubates infrequently use (as a first attempt after calling anesthesiology and waiting for them to get there)?

 

[PMPMD]

What would you guys recommend a doc in another specialty who intubates infrequently use (as a first attempt after calling anesthesiology and waiting for them to get there)?

Mac.

 

[jwk]

Mac is for amatuers. I'm a Miller man. Very few airways that can't be successfully intubated with a Miller 2/3. The Anesthesiology News article just confirms what I already knew as fact: Success more readily achieved with a Miller blade.

At least in Georgia, the Mac is considered the "professional blade". It takes skill and finesse to deftly indirectly lift the epiglottis and view airway gold. Anyone can traumatically mangle the epiglottis and muscle it in with a Miller, which is why we frequently refer to it as the nurse blade, Blade. 😀 (sorry, couldn't help myself).

So in case there's any doubt, I am and always have been a Mac guy. I even use Mac's on babies. I haven't personally attempted a gravid fire ant, because those suckers bite back!

The best blade, always, is the one you're most comfortable with - but if you don't learn and know how to use all of them, you're foolish. Somebody give me a Wis-Hipple 1.5, will ya?

 

[RussianJoo]

That's it tomorrow I am gonna try to intubate with a tongue blade! any words of advice?

 

[Bertelman]

That's it tomorrow I am gonna try to intubate with a tongue blade! any words of advice?

Don't let your attending see you try it.

 

[Planktonmd]

I think Blade (the anesthesiologist not the laryngoscope) has once again forgotten to take his pills!
😀

 

[Planktonmd]

Alternatively, you could probably take the same Miller blade and intubate anyways.

True, but a miller is rough and traumatic and above all it is mainly a CRNA blade so I choose to use a non CRNA blade!

 

[Bertelman]

True, but a miller is rough and traumatic and above all it is mainly a CRNA blade so I choose to use a non CRNA blade!

No, No, and I'm taking it back!!!

 

[Planktonmd]

No, No, and I'm taking it back!!!

Ok, Good for you 🙂

 

[urge]

Isn't 96% success kind of low? There have only been a handful of cases I haven't been able to intubate via DL in the past few yrs. That would require some sort of airway device a few times a week.

It is true CRNAs love the miller blade, everywhere. I use the Mac to bail them out just to mess with them.

 

[BLADEMDA]

No, No, and I'm taking it back!!!

Correct. The blade is an instrument nothing more. You can do gentle and finesse intubations with a miller blade. By the way, I was trained with the Mac blade and used it almost exclusively my first few years in practice. Then, I turned to the Miller blade once I realized its advantages in difficult situations.

 

[BLADEMDA]

Isn't 96% success kind of low? There have only been a handful of cases I haven't been able to intubate via DL in the past few yrs. That would require some sort of airway device a few times a week.

It is true CRNAs love the miller blade, everywhere. I use the Mac to bail them out just to mess with them.

I bail them out all the time as well with their same blade.

 

[Arch Guillotti]

FYI, the Miller blade requires significant strength for anterior airways which is why your CRNA fails frequently.

Disagree. I think it requires less strength for anterior airways than a Mac.

 

[Arch Guillotti]

The study quoted above doesn't mention a Mac blade at all.

How on earth can you possibly make the claim that the study "confirms" a Miller is superior to a Mac if the study didn't even look at Mac blades?

Because his search, copy and paste skills are second to none and when we are deluged with studies that most of us don't bother to read he can claim anything and have most people on the forum swallow it hook, line and sinker😀.

 

[fakin' the funk]

New Risk Index for Miller Blade Aids Adult Intubation

by Michael Vlessides

I cannot believe that Blade has gone from shotgun-post abstracts from real journals (Anesthesiology, A&A, others) to quoting an article from the FILTHY RAG that is Anesthesiology News.

Let's not encourage this behavior.

 

[fakin' the funk]

Don't let your attending see you try it.

I think probably 80% of my attendings would let me try it on a normal airway.

What I really wanna do is the blind digital intubation.

 

[fakin' the funk]

I don't think you're going to convince anyone to use a Miller blade using the "Miller High Life is awesome" argument.

If blades were named after beers, then I would use a "Green Flash Hop Head Red 3" laryngoscope every day.

On a serious note, I haven't run into too many anterior glottises...why would a Miller be better than a Mac for those?

 

[Arch Guillotti]

I don't think you're going to convince anyone to use a Miller blade using the "Miller High Life is awesome" argument.

If blades were named after beers, then I would use a "Green Flash Hop Head Red 3" laryngoscope every day.

On a serious note, I haven't run into too many anterior glottises...why would a Miller be better than a Mac for those?

Supposedly better at displacing tissue forward and out of the way.

I prefer dogfish head 90 Minute IPA myself😀.

 

[BLADEMDA]

I don't think you're going to convince anyone to use a Miller blade using the "Miller High Life is awesome" argument.

If blades were named after beers, then I would use a "Green Flash Hop Head Red 3" laryngoscope every day.

On a serious note, I haven't run into too many anterior glottises...why would a Miller be better than a Mac for those?

I like it. Green Flash Hop Head Red. Is this a new blade with a fiberoptic light?I like trying new beers. Thanks for the recommendation.

 

[soonerfrog]

Two words: Franziskaner. It's a Hefe from Munich.

 

[Oggg]

Stone IPA.

 

[Monty Python]

Phillips 2. Best of Miller and Mac combined.

 

[BLADEMDA]

Phillips 2. Best of Miller and Mac combined.

Nice blade. Do you use it most of the time like a MAc or do you go under the epiglottis directly to the cords like a Miller? It seems like you have a choice and that is nice

 

[Monty Python]

Nice blade. Do you use it most of the time like a MAc or do you go under the epiglottis directly to the cords like a Miller? It seems like you have a choice and that is nice

I don't start out a DL intentionally trying to get it one way versus the other. I just take what anatomically comes at first glance as I try to minimize manipulating the tissues. Anecdotally the Phillips 2 gives me a Miller-like view 66% of the time, and a Mac-like view 33% of the time.

 

[periopdoc]

Mac vs Miller

- pod

 

[MTGas2B]

Pizza port beers. Ummmm


On the iPhone

 

[Colba55o]

Has anyone mentioned anything about speed? For RSIs I prefer MACs because on straightforward airways I think its quicker to use the MAC because as someone stated you don't need to finesse the blade underneath the epiglottis.

Also, wouldn't esophageal intubations be more common with the Miller? I have had 2 of these and both were with the miller which is more likely to be advanced too deep, past the cords. In some people when you lift up and expose your view, the goose looks a lot like the cords, especially when the sats are low

 

[BLADEMDA]

Has anyone mentioned anything about speed? For RSIs I prefer MACs because on straightforward airways I think its quicker to use the MAC because as someone stated you don't need to finesse the blade underneath the epiglottis.

Also, wouldn't esophageal intubations be more common with the Miller? I have had 2 of these and both were with the miller which is more likely to be advanced too deep, past the cords. In some people when you lift up and expose your view, the goose looks a lot like the cords, especially when the sats are low

Get good with your MAC blade. Then, if you feel inclined become proficient with the Miller blade for anterior airways.

Recently, a CRNA couldn't see the cords with her Miller 2 blade. I could tell she was too deep with the blade; I convinced her to change blades to a MAC 3 so she could get the intubation. She reluctantly agreed to do so and was successful with the intubation.

In the end, it comes down to skill and experience which the Miller blade requires more of than a MAC. I do think your first 100 intubations should be with a MAC blade before considering the Miller. Since time matters in my practice and I am supervising CRNAs frequently I use the blade which has the greatest chance of success in my hands.

 

[BobBarker]

I use a Mac blade most of the time but occasionally when I use a miller I get attitude from certain attendings. "Oh, you are a straight blade man. I didn't know.." in the same tone as "Oh, you give BJs in the men's restroom at the park. I didn't know.." F'em.

Sometimes your old posts make you laugh. I used the miller blade exclusively as a CA2 on back to back months of pediatric anesthesia. Airway obtained everytime. From 1kg to 100kgs. Definitely made me comfortable with the straight blade. Last night I intubated a lanky 6' black guy with a grade 1 view using the ' ol miller 3. He had been a bougie with the Mac 3 the previous anesthetic. Long live the Miller! Hell, Im looking for the next opportunity to deploy a Miller 4, locally known as the ninja sword.

 

[urge]

Sometimes your old posts make you laugh. I used the miller blade exclusively as a CA2 on back to back months of pediatric anesthesia. Airway obtained everytime. From 1kg to 100kgs. Definitely made me comfortable with the straight blade. Last night I intubated a lanky 6' black guy with a grade 1 view using the ' ol miller 3. He had been a bougie with the Mac 3 the previous anesthetic. Long live the Miller! Hell, Im looking for the next opportunity to deploy a Miller 4, locally known as the ninja sword.

Bet he would have been a bougie intibation with a Miller 2. It's just the wrong length of the blade, not the shape.

 

[somedumbDO]

Mac is for amatuers. I'm a Miller man. Very few airways that can't be successfully intubated with a Miller 2/3. The Anesthesiology News article just confirms what I already knew as fact: Success more readily achieved with a Miller blade.

Miller 2 man plus one... 95% of the time other 5% ?? Miller 1

 

[drmwvr]

Did you see the Anesthesiology News article where they used the Miller blade routinely and obtained success 96 percent of the time?

In my practice the Miller blade is used 3 to 1 over the Mac blade for routine intubations.
We already knew that since your first attempt is supposed to be successful why not utilize the laryngoscope blade which does exactly that: Miller 2

I imagine most private practices with experienced people use the Miller blade routinely while academia utilizes Mac 3/4. Once I was in practice for about 12-18 months I switched to the Miller 2 for all my intubations and never looked back. Now, the only time I use the MAc blade is for teaching purposes, double lumen tube placement (edentulous) and when that's the only blade in the drawer.

As for sore throats being greater with Miller vs Mac that's operater dependent and we haven't seen it.

As an aside, never understood why people who swear by Millers drop them for a Mac just because they're placing a DLT, edentulous or otherwise. The admonitions for the Mac here are rubbish.

 

[OB1🤙]

I am perfectly fine with a Miller in my hands, but prefer the Mac. If I think they may be anterior, I'll go Miller first.

I'll also from time to time use a Miller all week for a week, just to keep "in practice" with it. My techs think I'm nuts. They're probably right.

 

[Dejavu]

Did you see the Anesthesiology News article where they used the Miller blade routinely and obtained success 96 percent of the time?

In my practice the Miller blade is used 3 to 1 over the Mac blade for routine intubations.
We already knew that since your first attempt is supposed to be successful why not utilize the laryngoscope blade which does exactly that: Miller 2

I imagine most private practices with experienced people use the Miller blade routinely while academia utilizes Mac 3/4. Once I was in practice for about 12-18 months I switched to the Miller 2 for all my intubations and never looked back. Now, the only time I use the MAc blade is for teaching purposes, double lumen tube placement (edentulous) and when that's the only blade in the drawer.

As for sore throats being greater with Miller vs Mac that's operater dependent and we haven't seen it.

Being a Miller guy, I like to give Mac guys I work with as much crap as possible about the "bent piece of angle iron" in their hand. Until one of them pointed out, in this day of everybody using the Glidescope at the first sign of trouble, that "maybe the Glide is shaped like a Mac for a reason". Don't know that I had a comeback for that, other than "It is a sign of weakness to ask for the Glidescope".

 

[drmwvr]

Being a Miller guy, I like to give Mac guys I work with as much crap as possible about the "bent piece of angle iron" in their hand. Until one of them pointed out, in this day of everybody using the Glidescope at the first sign of trouble, that "maybe the Glide is shaped like a Mac for a reason". Don't know that I had a comeback for that, other than "It is a sign of weakness to ask for the Glidescope".

the glidescope isn't shaped like a mac. tell your mate he should try do a DL with one.

 

[Dwindlin]

the glidescope isn't shaped like a mac. tell your mate he should try do a DL with one.

This was the first thing that popped into my mind as well lol.

 

[Mac4]

We do use glidescope the way as we do with Mac.

I have no preference. If CRNA/senior resident can not intubate, I will use a different blade (most likely to be Mac since miller is the No.1 choice for most of people here).

 

[urge]

the glidescope isn't shaped like a mac. tell your mate he should try do a DL with one.

Closer to a Mac than a Miller.

 

[Dejavu]

Closer to a Mac than a Miller.

Thank you. I thought I was the only one who saw the similarities between a Glide and a Mac.

 

[imfrankie]

I usually don't participate in the gun discussions but this one is worth it.
I disagree that 9mm is bad because with the right 9mm ammunition and 17 bullets in the magazine you have incredible stopping power at your finger tip.
That said, I recently got a Sig 1911 and absolutely love it!
I still keep a full magazine of good hollow point in my Glock 17 for my home defense, right next to my shotgun of course 😀

"Stopping power?" Who are you stopping?

 

[imfrankie]

"Stopping power?" Who are you stopping?

Not sure I've used a Mac blade since anesthesia rotation in 3rd year of medical school.

 

[Planktonmd]

"Stopping power?" Who are you stopping?

When someone is high on crack and charging forward to kill you then rape your wife you need stopping power, one or two 9 mm bullets might not be enough.

 

[drmwvr]

When someone is high on crack and charging forward to kill you then rape your wife you need stopping power, one or two 9 mm bullets might not be enough.

Well, not to split hairs, two high quality hollow point 9mm rounds are every bit as good as two .45 rounds, providing they're placed somewhere lethal.