Miller vs Mac Contraversey!

jwk · Mar 23, 2006

Ok all
So i decided i would ask and see what everyone seems to like and why.
I use both equally well ( I attribute that to one CRNA and one MDA for forced me to tube everyone one day with a miller ;P). However, i have a prefrence depending on the patient.
Mac
- Standard adult intubation No cspine
Miller
- Anterior airway
- Short thick neck
- Pediatrics (pick up the epiglottis)
- ANY C-Spined pt.
Anyone else? Whats your preference? Why?

Mac of course.

Interesting you would choose a straight blade for C-Spines - I think you minimize movement better with a Mac.

If you really want to see well, try a Glidescope, essentially a Mac blade with a TV camera at the end - awesome view, NO neck movement. We've actually used it instead of FOB on a couple of patients including C-spines. Loved it.

MmacFN · Mar 23, 2006

Hey

Yes the reason i use a miller as opposed to a mac has more to do with the decrease in visibility with the mac due to the curve of the blade. Hold 2 of them side by side where the connecting point of the blades are level. Turn them to the side. You notice a .5 cm difference (or so) in how far the curved blade obscures the view. In my experience the less i have to manipulate the better, with .5 cm in the difference looking straight down the blade i find i lift less, a technique taught to me by an MDA here. Works well!

The glidescope is cool, but has no place in pre hospital. Sadly, a bloody airway ruins it Ive played with it on a couple occasions in the OR and was amazed. Do you use it all the time or is it just a toy for here and there?

rn29306 · Mar 23, 2006

Use MAC almost exclusively.

The Miller partially obscures the view by nature of it directly lifiting the epiglottis, for me at least. Tongue control is obviously harder with the Miller. I guess it is what I have gotten used to.

sonessrna · Mar 23, 2006

I LOVE the MIller. BUt there are definitely times where I can't see with the Miller. I feel pretty competent with both, but sometimes it just depends on the patient. Small mouth opening, probably a MAC for me. C-spines, I usually just go to the FOB. Trauma, MAC and inline stabilization. ANyway...that's me.

MmacFN · Mar 23, 2006

good points all!

Funny how everyone is different isnt it? There is no answer except "whatever gets the tube in" :)

Its fun to debate though.

yoga crna · Mar 24, 2006

Miller 2 blade, MAC computer.

Yoga

GCShore · Mar 24, 2006

Miller 2 blade, MAC computer.
Yoga

:lol2: :lol2:

MmacFN · Mar 24, 2006

hehehehhe

gaspassah · Mar 24, 2006

well you'll probably look at me strange like everyone else but i like the small pediatric handle with a miller 4 blade, i intubate 99 percent of my patients like this. if you like a miller blade try a mil 4, you get almost the same if not more exposure than a mac, but all the miller attributes. and yes i use it on little old ladies too.

d

yoga crna · Mar 24, 2006

Gas,

I learned to intubate with the Miller 4 and agree that it is great. Through the years, I have downsized to the Miller 2 or 3, for large men. I still use the #4 for certain cases and am glad I have it around. The majority of my intubations are nasal, so I like the smaller blade if I need the Magill Forceps.

I have a question regarding the pediatric handle. Back when I was in a hospital practice, I found it useful when intubating patients with large breasts that fell back on the neck--especially c-sections. But, the battery seemed to deplete quickly and the light fade, just when it was most needed. Have you found this to be a problem?

In my current plastic surgery practice, we mostly see small breasts being made larger, so it is not so much of an issue.

I also use the Mac blade on occasion, just to keep up those skills. Sometimes, it just seems to work better.

Does anyone know the cost of the glide scope? I may consider buying one for the really difficult intubations. When you work alone like I do, one needs to consider back-up equipment.

Yoga CRNA

MmacFN · Mar 24, 2006

I think that if it works thats all that matters!