IMPROVEMENT OF THE GLOTTIS VISUALIZATION WITH THE MCCOY BLADE

Difficult intubation remains one of the major risks in anaesthetic pra ctice. Recently, as other anaesthetic societies, the French Society fo r Anaesthesia and Intensive Care (SFAR) has produced algorithms for th e management of a difficult intubation. New laryngoscopes and blades h ave been marketed in recent years, however their place in these algori thms remains unclear. In this preliminary study, we compared the laryn goscopic view in 100 consecutive patients during tracheal intubation w ith the McCoy laryngoscope first in its normal position and after leve ring the distal part of the blade. All patients were included in Malla mpati classes 1 and 2. Among them, 16% were classified as Cormack and Lehane grades 3 or 4 when using the blade in the normal position. Thes e data confirm previous observations showing that the McCoy blade in n ormal position performs poorly as compared with the Macintosh blade. C onversely the revering of the distal part of the blade significantly d ecreased the incidence of Cormack and Lehane grades of 3 or 4 (2 versu s 16%, P = 0.001). It is concluded that the McCoy blade is not conveni ent for its routine use in patients not to be at preoperatively known risk of difficult intubation. This blade significantly improves intuba ting conditions. Defining the exact place of this new blade in difficu lt intubation algorithms requires further studies. (C) 1998 Elsevier, Paris.