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Pediatric DL Blades

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

What's your blade preference for DL in an 18 month old?

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pemsou5_wp • November 12, 2021

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  1. Kelly November 14, 2021 - 6:15 pm Reply

    While straight (Miller, Wis-Hipple) blades are generally recommended for pediatric direct laryngoscopy, some practitioners anecdotally prefer the curved Mac blade, either used as intended by placement in the vallecula, or used as straight blades are used by lifting the epiglottis. Literature is sparse on this subject, and often uses POGO (percent of glottic opening) scores as the main outcome. POGO may not be the only nor most important factor influencing successful intubation. Elattar et al ( did not find significantly different POGO scores between Miller, Wis-Hipple, and Mac blades, although in some posthoc further calculations Miller gave a better view than Mac. Varghese et al ( found the Miller and Mac blades to give similar glottic views and % easy intubations. Passi et al ( also found no difference in POGO scores between the Miller and Mac blades used as intended, and the Miller blade used as a Mac blade in the vallecula. However, POGO scores were worse when the Mac blade was used as a Miller blade to lift the epiglottis. All of these studies were in children < 2 years old. It is likely that individual preference and experience is one of the most important factors.

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