Comparison of Hemodynamic Response to Laryngoscopy Using Miller and McCoy Blade

• Published in: Curēus (Palo Alto, CA) Vol. 14; no. 5; p. e24914
• Main Authors: Mahadevaiah, Thejeswini, T S, Deepak, Rani, Roopa, K N, Vikas, G M, Shwetha
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 11.05.2022; Cureus
• Subjects: Anesthesia; Anesthesiology; Blood pressure; Cardiac arrhythmia; Epiglottis; Heart rate; Hemodynamics; Hypertension; Intubation; Laryngoscopy; Larynx; Patients; Surgery; laryngoscopy; intubation; pressor response; miller blade; mccoy blade
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.24914

The most commonly used equipment to aid endotracheal intubation is a laryngoscope, and the procedure performed is known as laryngoscopy, which leads to profound cardiovascular effects. The process of laryngoscopy causes the release of catecholamines, thereby leading to marked pressor responses and tachycardia. The process of laryngoscopy can be made easier by the use of various types of laryngoscopic blades. The McCoy blade is a modification of the standard Macintosh blade that incorporates a hinged tip blade. It allows elevation of the epiglottis while decreasing overall laryngeal movement. A Miller blade is a straight blade with a slight upward curve near the tip. It is found that the force exerted, head extension, and cervical spine movement are less with the Miller blade. This study was undertaken to compare changes in haemodynamic parameters before, during, and after laryngoscopy using these two blades. Following institutional ethical committee approval and obtaining informed written consent, 100 patients of American Society of Anesthesiologists (ASA) grades I and II in the age group of 18-45 years of either sex undergoing elective surgeries under general anaesthesia were included in the study. The patients were randomly allocated into two groups of 50 patients each. Group Mc - laryngoscopy was performed using a no. 3 McCoy blade. Group Ml - laryngoscopy was performed using a no. 2 Miller blade. The laryngoscopic view was compared using Cormack and Lehane grading. Haemodynamic parameters before, during, and after laryngoscopy were recorded. Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were increased in both the groups but were statistically and clinically significant in the Miller group with p≤0.001. McCoy blade is associated with a significantly more stable hemodynamic response to laryngoscopy in comparison with the Miller blade.