why is it that crnas always use a miller blade?

[urge]

It's sickening to see them struggle over and over just because they want to use the miller 3 on everyone. Is it a pride thing? Are they taught the idea that it is the better blade? Any comments?

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[coprolalia]

Can't say that I've ever watched a CRNA intubate. Sorry. If I'm in the room, I'm putting the tube in. You should try it. 🙂

-copro

 

[Trisomy13]

they are very angry at the front teeth.

 

[Dejavu]

Thirty years ago, I started out life as a CRNA and learned intubating with a Wis-Foregger blade. As an anesthesiologist, I have predominantly used a Miller 2 ever since, but definitely see some advantages to a Mac blade.

Looking back over the years, my impression (non-scientific, no data to support it) is that I have rarely had a better view with a Mac than I had with a Miller #2.

I do get a lot of enjoyment out of giving my residents and student CRNAs grief about "handicapping" themselves with that "bent piece of angle-iron" (Mac blade). Just something I joke around with in an attempt to brighten everyones day.

Mostly it doesn't matter, just get the dam* tube in.

Just my $0.02.

 

[Tenesma]

i rarely use/used a MAC except for maybe my 1st two years of training...

Miller rocks...

If you think about it, what do the ENTs and Thoracic surgeons use on very difficult airways? they use a rigid bronch...

The trick with the miller is learning how to use it carefully and properly -

 

[VentdependenT]

If I could only have one blade it would be a MAC 3

 

[veetz]

From my limited experience as a CA-1, it seems that most everyone who's beyond a year or two of anethesia training (residents, crnas, attendings, etc) seem to prefer straight blades over curved ones.

 

[georgia_aa]

The ONLY blade I use is the Miller 3. As I tell my students, once you truely master the straight blade, it renders the curved blade obsolete. I get tubes in people on one attempt, after multiple attempts by others. It is clearly a harder blade to master but is well worth the effort.

 

[urge]

I don't want to say inferiority complex but I guess is already too late.

 

[Sevo]

From my limited experience as a CA-1, it seems that most everyone who's beyond a year or two of anethesia training (residents, crnas, attendings, etc) seem to prefer straight blades over curved ones.

I would say 1/4 of my group uses MACs and the remainder use Millers.

I've gotten several "difficult" Miller airways with a MAC 4. It's really what you feel confident using.

 

[FLK 1]

I've gotten several "difficult" Miller airways with a MAC 4. It's really what you feel confident using.

Thank you, I’ve witnessed this more than a few times too. There is a mythology out there that the miller is superior for difficult airways. I don’t know where this comes from, but it seems to be propagated by many CRNA’s and those anesthesiologists who are quick to dismiss the mac blade as a newbie’s choice. Let me just say that there are many anesthesiologists who are just as skilled with a curved blade as anyone out there is with a straight blade. It’s not the blade that matters, it’s the hands.

 

[Planktonmd]

Thank you, I’ve witnessed this more than a few times too. There is a mythology out there that the miller is superior for difficult airways. I don’t know where this comes from, but it seems to be propagated by many CRNA’s and those anesthesiologists who are quick to dismiss the mac blade as a newbie’s choice. Let me just say that there are many anesthesiologists who are just as skilled with a curved blade as anyone out there is with a straight blade. It’s not the blade that matters, it’s the hands.

Exactly. 👍

 

[jetproppilot]

It's sickening to see them struggle over and over just because they want to use the miller 3 on everyone. Is it a pride thing? Are they taught the idea that it is the better blade? Any comments?

I can intubate a gravid fire ant with a Miller 2.

I'm not saying it is the superior blade.

I dont think there is such a thing.

The Chair of my residency program could intubate a gravid amoeba with a Mac 3. He was English, thats what he used his whole career. And man, he was great.

But the Miller 2 is what I'm best with, for whatever reason.

 

[Planktonmd]

I can intubate a gravid fire ant with a Miller 2.

I'm not saying it is the superior blade.

I dont think there is such a thing.

The Chair of my residency program could intubate a gravid amoeba with a Mac 3. He was English, thats what he used his whole career. And man, he was great.

But the Miller 2 is what I'm best with, for whatever reason.

I bet I can intubate both your ant and his amoeba with a MAC 4.

 

[jetproppilot]

I bet I can intubate both your ant and his amoeba with a MAC 4.

And I believe you.

 

[militarymd]

I bet I can intubate both your ant and his amoeba with a MAC 4.

And I believe you.

I'll have to see for myself....

I personally don't have a favorite blade...I just grab what's clean.

 

[coprolalia]

I personally don't have a favorite blade...I just grab what's clean.

Ditto (at least that's the ideal).

It's a poor carpenter who blames his tools.

-copro

 

[seinfeld]

I have never gotten a worse view with the miller, but at times have changed a grade 3 view into a much less tachycardic grade 2 with the miller. In patients with high arched palates, those with short thyromental distance, and in peds with that darn floppy epiglottis i perfer a miller. I still use MAC with double lumens as it gives more room.

In the end for the average patient,like mil said, just give me a clean blade

I thought the miller was a tougher blade to learn to intubate on perhaps the CRNAs are trying to seem more advanced in there skills ???? but in reality its probably just what they are more comfortable with.

In the end get the tube in and no one will care what you used.

 

[oudoc08]

When I was in paramedic school over 10 years ago, I developed a preference for the Miller for one reason...

We started intubating plastic manikins before peope, and the less pliable manikin had that plastic epiglottis that always got in the way.

With the Mac, even w/ proper technique, it still didn't move right, so I got used to having the Miller to move it out of the way.

Then, it just became the familiar choice.

When I started my anesthesia rotations, my preceptors made me try the Mac, and I have to say, with a much more "pliable" person, the Mac worked just fine.

I had a guy w/ post radiation fibrosis in the neck, and when I tried a Mac it felt like the old manikins. I ended up using a Miller to get it, but in retrospect, can't you just use the Mac to pick up the epiglottis? Not the way it was designed, but it seems like it would work just fine.

(Also, I've started to like the Mac for having the flange to help push the tongue aside. )

 

[McSnappy]

Most of the experience I've had is with the simulator and dummies...so grain of salt thing here. I've only intubated 4 live. MSIII
We had didactics the other day with some dummies (excluding us students😉) and the women in the group had a lot more difficulty with the Miller. Our attending said until they develop more technique and then stop using the teeth as a fulcrum😀, the Mac will be easier for them.
I liked the Miller.. it seemed to give me more room. I was given the Mac with the live patients each time.

 

[OldManDave]

Who gives a rat's *** if you use the bumper off of a buick!?!? As long as you get the damned tube in & and do it with style...the brand of hammer is a moot point. Besides, the mere fact we play with airways all day long is enough to make most Docs wet their BVDS anyhow!

Gas ROCKS!

 

[zippy2u]

Perhaps they were farmers in a previous life. Jeez, put a miller 3 behind a water buffalo and ya could plow some serious acreage. At any rate the mac blade is more aesthetically pleasing to the eye, representing refinement--reminds me of the gentle curves of a woman's bottom... Regards, ----Zip

 

[Ketamininus]

Who gives a rat's *** if you use the bumper off of a buick!?!? As long as you get the damned tube in & and do it with style...the brand of hammer is a moot point. Besides, the mere fact we play with airways all day long is enough to make most Docs wet their BVDS anyhow!

Gas ROCKS!

Hear, hear! I pretty much agree with how Dave spelled it out. The blade matters a lot less than whether you succeed or fail. I tend to use a Mac more than Miller, but I'll use whichever gives me the better chance of an easy intubation. I've found some tough ones that do better with the Miller than Mac, and vice-versa, so I couldn't make a sweeping generalization about it.

Just get the tube in place...in the correct place.