Department of Anesthesiology and Intensive Care, Marmara University School of Medicine, Istanbul, Turkey.
Oishei Children's Hospital, Jacob's School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA.
Anaesthesiol Intensive Ther. 2021;53(3):246-251. doi: 10.5114/ait.2021.108561.
Both the Miller and Macintosh blades are commonly used during laryngoscopy in infants and children, although the glottic views have not been compared in neonates. This study compared the glottic views with the Miller and Macintosh size 0 blades in neonates when the blades were placed above and below the epiglottis.
Forty anaesthetized and paralyzed neonates undergoing elective surgery were enrolled and randomized to either the Miller or Macintosh size 0 blade. Two glottic views were obtained in random order in each neonate and were photographed using the same blade: lifting the epiglottis first then the tongue base or vice versa. The percentage of glottic opening (POGO) scores were evaluated with each view. The POGO scores and cardiorespiratory variables were then analysed.
The POGO scores using the Miller blade to lift both the epiglottis and the tongue base were similar, whereas the scores using the Macintosh blade to lift the epiglottis were greater than those to lift the tongue base. The POGO scores using the Miller blade in both positions were significantly greater than those using the Macintosh blade in the corresponding positions (P = 0.0001). The heart rate using the Miller blade was greater than that using the Macintosh blade (P = 0.0001).
In neonates, the glottic views using the Miller size 0 blade to lift both the epiglottis and the tongue base were deemed to be excellent and superior to those using the Macintosh blade in both positions.
在婴儿和儿童的喉镜检查中，米勒刀片和麦克intosh 刀片都被广泛使用，尽管尚未在新生儿中比较过声门视图。本研究比较了在将 epiglottis 置于叶片上方和下方时，新生儿使用 Miller 和 Macintosh 尺寸 0 叶片的声门视图。
40 名接受择期手术的麻醉和瘫痪新生儿被纳入并随机分为 Miller 或 Macintosh 尺寸 0 刀片组。在每个新生儿中以随机顺序获得两种声门视图，并使用相同的叶片拍照：首先提起 epiglottis，然后提起舌骨基底或反之亦然。用每种视图评估声门开放百分比（POGO）评分。然后分析 POGO 评分和心肺变量。
使用 Miller 叶片提起 epiglottis 和舌骨基底时的 POGO 评分相似，而使用 Macintosh 叶片提起 epiglottis 的评分大于提起舌骨基底的评分。两种位置使用 Miller 叶片的 POGO 评分均显著大于相应位置使用 Macintosh 叶片的 POGO 评分（P = 0.0001）。使用 Miller 叶片时的心率大于使用 Macintosh 叶片时的心率（P = 0.0001）。
在新生儿中，使用 Miller 尺寸 0 叶片提起 epiglottis 和舌骨基底的声门视图被认为是极好的，并且优于在两个位置使用 Macintosh 叶片。
