The Difficult Airway in Adult Critical Care

Gavin G. Lavery, MD, FCARSCI, MB, BCh, BAO; Brian V. McCloskey, MB, BCh, FRCA, FFARCSI, MRCP


Crit Care Med. 2008;36(7):2163-2173. 

In This Article

Choice of Laryngoscope Blade

There are over 50 types of curved and straight laryngoscope blades of varying sizes. Using specific blades in certain circumstances is felt to be very advantageous by some[101,102,103] but not all authorities.[104] In patients with a large lower jaw or deep pharynx, the view at laryngoscopy may be improved significantly by using a size 4 Mackintosh blade (rather than the more common size 3) to ensure the tip of the blade reaches the base of the vallecula to facilitate optimal elevation of the epiglottis. Other blades, for example, McCoy (a curved Mackintosh-type blade with a laryngoscopist-controlled hinged portion just proximal to the tip), may be advantageous in specific situations.[105,106] Figure 3 shows a selection of curved and straight laryngoscope blades.

Lateral view of straight and curved laryngoscope blades. A-C, Mackintosh Blades (sizes 4, 3, and 2). D, Miller blade; E, McCoy blade (tip in elevated position).


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