Which laryngoscope blade would you choose when intubating a child?
Which laryngoscope blade would you choose when intubating a child?
The Miller (straight) laryngoscope blade is regarded as the preferred blade to expose the laryngeal inlet in infants and children during tracheal intubation.
Which laryngoscope blade is most commonly used in a neonate?
The straight Miller laryngoscope blade is traditionally recommended for intubation in infants, due to the large size and flexibility of the infant epiglottis.
When do you use Macintosh or Miller?
The Macintosh is also thought to be less traumatic to the teeth and to provide more room for passage of the tracheal tube through the oropharynx. However, the Miller provides a better view of the glottis in a patient with a long, floppy epiglottis, or an anterior larynx.
Why are Miller blades used for neonates?
In neonatal tracheal intubations, Miller blade is the most frequently utilized blade (6). The reasons for this include the effective displacement of the tongue to the left of the laryngoscope with the Miller blade and the effective lifting of the long and floppy epiglottis during laryngoscopy (3).
What size laryngoscope blade should be used to intubate a newborn with an estimated gestational age of 30 weeks?
Using this rule, a 2.5mm ID endotracheal tube would be used for an infant born at 25 weeks’ gestation, a 3.0mm ID for an infant born at 30 weeks and a 3.5mm ID for an infant born at 35 weeks’ gestation.
What size is a laryngoscope?
A laryngoscope with a straight blade (size 1 [10 cm] for term infants and larger pre term infants, size 0 [7.5 cm] for premature infants < 32 w or 00 [6cm] for extremely low birth weight infants) is preferred. Some experienced operators use curved blades.
What blades are available for video laryngoscopy in pediatrics?
Five different blades are now available for video laryngoscopy in pediatrics and neonatology: MILLER 0 and 1, MACINTOSH 0 and 2 as well as the D-BLADE Ped. The latter was especially designed for managing difficult airways in children and closes the gap between MACINTOSH video laryngoscopes and flexible endoscopes.
What are the different sizes of laryngoscopes?
This laryngoscope is manufactured in three sizes: adult, pediatric, and pediatric long.30 The adult size, with a blade that is 2.5 cm wide, is suitable for children older than 10 years. The pediatric version (newborn to age 2 years) has a blade 1.3 cm wide that extends 0.6 cm beyond the fiberoptics.
How is laryngoscopy performed in infants and small children?
Laryngoscopy in infants and small children is a technically easier procedure than in adults. Mouth opening, jaw joint mobility, and dentition are all more favorable for laryngeal exposure in children vs adults. Smaller diameter tracheal tubes relative to the lumen of laryngoscope blades make tube insertion and target visualization easier as well.
Can a laryngoscope blade be used to identify the epiglottis?
Using a straight blade with a small flange can make epiglottis identification and effective tongue control challenging. Fortunately, the small diameter pediatric tracheal tubes, especially un-cuffed tubes, relative to the lumen of the laryngoscope blade, makes tube passage possible even when the tongue is not optimally controlled.
