Blade of choice

[esclavo]

I differed alot from my chief-resident a few years ago on this burning question. Pick your universal Larygoscope blade and defend it. We had it out for over a month and in the end we both learned alot of small but important considerations when picking a blade. I am curious to know what is the preferred blade out there amongst dental residents and then the rational or experiences leading to that blade choice. This isn't a trap, there are no right answers only good explanations.

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[toofache32]

I grab a Mac 3 (or 4 if they're tall or neck looks long) first for no real reason. The Millers are good if they have a big floppy epiglottis, but I think we all know that each has its place. The best one, in my opinion, is the one you use the most because that's what you're gonna be the most comfortable with.

 

[Jediwendell]

Many seasoned anesthesiologists seemed to use the Millers more. I like the Miller better, but it just takes some time to get used to. The Mac has a reputation for being "easier", but I don't see how your basic intubation could get much easier. Not to say they are all easy, some are a complete beast. Those are usually done fiberoptically now, though. For people in a C-collar I found a Miller to give better vision.

 

[rrc]

I differed alot from my chief-resident a few years ago on this burning question. Pick your universal Larygoscope blade and defend it. We had it out for over a month and in the end we both learned alot of small but important considerations when picking a blade. I am curious to know what is the preferred blade out there amongst dental residents and then the rational or experiences leading to that blade choice. This isn't a trap, there are no right answers only good explanations.

As an OMS, if you have a mac or miller in your hand, and you're not on anesthesia, something very bad has happened, thus I prefer neither!

 

[esclavo]

As an OMS, if you have a mac or miller in your hand, and you're not on anesthesia, something very bad has happened, thus I prefer neither!

I understand this to a certain extent, but what about those few instances where a MAC turns into a general for better patient care/protection. Not every 300 pound flailing nervous 27 year old male with a neck like Jabba the hut can have his thirds out and be done light enough to keep the pulse oxymeter above 84! Are you saying you screen patients well enough and have surgery center priveleges that afford you and your patients the ability to increase the cost 120-250 percent? Or would you bring in an anesthetist? I consider my intubation skills the corner stone of my airway skills which is why I can offer the anesthesia options I do. The question of a blade is extremely relevant if you plan on giving more than 10 of versed and 100 of fentanyl. I don't go to work saying, "wow, I'd like to intubate a third molar patient today", but at the same time, I feel rock solid and wouldn't hesitate in a second to secure an airway; Beats aspiration, apnea, bronchospasm etcetera.

 

[rrc]

I understand this to a certain extent, but what about those few instances where a MAC turns into a general for better patient care/protection. Not every 300 pound flailing nervous 27 year old male with a neck like Jabba the hut can have his thirds out and be done light enough to keep the pulse oxymeter above 84! Are you saying you screen patients well enough and have surgery center priveleges that afford you and your patients the ability to increase the cost 120-250 percent? Or would you bring in an anesthetist? I consider my intubation skills the corner stone of my airway skills which is why I can offer the anesthesia options I do. The question of a blade is extremely relevant if you plan on giving more than 10 of versed and 100 of fentanyl. I don't go to work saying, "wow, I'd like to intubate a third molar patient today", but at the same time, I feel rock solid and wouldn't hesitate in a second to secure an airway; Beats aspiration, apnea, bronchospasm etcetera.

Of course you need intubation skills should the need arise. But like I said, it's not a routine thing to do. If a patient needs to be intubated for surgery due to medical issues or morbid obesity, OSA, etc, then a second person needs to run the ventilator. We have a GA room and a CRNA comes in to do it.

 

[esclavo]

Of course you need intubation skills should the need arise. But like I said, it's not a routine thing to do. If a patient needs to be intubated for surgery due to medical issues or morbid obesity, OSA, etc, then a second person needs to run the ventilator. We have a GA room and a CRNA comes in to do it.

Anyone can handle the routine. Of course I am talking about the "non routine". I think there is a reason OMFS accredidation standards require more time in anesthesia than any other specific service. When a CRNA comes into my office to help with OETGA case, they operate under my license (thus I am required to understand all the issues that my CRNA will face). When I took mock oral boards in Chicago last year, the faculty of the staff supervising the examination pushed anesthesia issues requiring thorough thought and comprehension of the yings and yangs. When your office is approved by the state OMFS society (most state organizations require and officiate this), they take you down these paths which require knowledge and decisive answers. My original question was to generate discussion on blade usage (a survey) and the yings and yangs (experience/knowledge/preference). I was hoping for OMFS residents to share some gems. I guess I am weird because I have taken care of airways (tubed) on all types of patients in the ED, on the floor, in the office, and in the OR (babies, kids, the fit, the fat, C-collars, cervical spine fusions, ankylosis spondilitis, spine trauma, syndromic people). Trauma surgeons, Pediatric intensivists, and my attendings expect me to have deft ability. The toughest situations I have encountered are not when I have been on anesthesia (ideal conditions). I still am trying to arrive at my own level of expectations when it comes to airway management, I want to be a bad !@#$!#%!@#$ in this department. The number one untoward anesthesia effect in the OMFS office is hypoxia Let the discussion continue. My next question (thread) will follow this one.