{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T14:22:33Z","timestamp":1775139753837,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The primary objective of this study was to demonstrate whether the Miller blade laryngoscope could provide better visualization of the vocal cords in morbidly obese patients than the Macintosh blade laryngoscope. The secondary objective was to identify the patient-measured factors associated with better visualization of the vocal cords when using the Miller vs. Macintosh blade, as well as whether the application of external pressure might improve the visibility of the glottis during intubation. A prospective, observational study encompassing 110 patients with a BMI &gt; 40 undergoing elective bariatric surgery and intubation procedure was performed. The evaluation of the vocal cords was performed according to the Cormack\u2013Lehane scale and POGO scale in the same patient during intubation, performed with a Miller and a Macintosh blade laryngoscope, in a random matter. The following parameters were assessed: body weight, height, BMI, neck circumference, thyromental distance, sternomental distance, mouth opening, and Mallampati scale and their impact on visualization of the vocal cords using the Miller blade without the application of external pressure. The Miller blade provides an improved view of the glottis compared to the Macintosh blade measured with both the Cormac\u2013Lehane scale (45 (40.91%) without external pressure application on the larynx, and 18 (16.36%) with external pressure application on the larynx) and the POGO scale (45 (40.91%) without external pressure application on the larynx, and 19 (17.27%) with external pressure application on the larynx). The application of laryngeal pressure improved the view of the glottis. Among the measured features, a significant improvement in the visibility of the glottis could be found in patients with a BMI over 44.244 kg\/m2 and a neck circumference over 46 cm. To conclude, the usage of the Miller blade improves the visibility of the glottis compared to the Macintosh blade in morbidly obese patients. The recommendation to use the Miller blade in this group of patients requires further investigation, taking into account the effectiveness of the intubation. Trial Registration: NCT05494463.<\/jats:p>","DOI":"10.3390\/jcm13030681","type":"journal-article","created":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T09:57:42Z","timestamp":1706090262000},"page":"681","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Comparison of Miller Straight Blade and Macintosh Blade Laryngoscopes for Intubation in Morbidly Obese Patients"],"prefix":"10.3390","volume":"13","author":[{"given":"Pawel","family":"Ratajczyk","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-419 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9330-2160","authenticated-orcid":false,"given":"Przemys\u0142aw","family":"Kluj","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-419 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bartosz","family":"Szmyd","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, 90-419 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Resch","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-419 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piotr","family":"Hogendorf","sequence":"additional","affiliation":[{"name":"Department of General and Transplant Surgery, Medical University of Lodz, 90-419 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Durczynski","sequence":"additional","affiliation":[{"name":"Department of General and Transplant Surgery, Medical University of Lodz, 90-419 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5250-3978","authenticated-orcid":false,"given":"Tomasz","family":"Gaszynski","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-419 Lodz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Nicholson, A., Smith, A.F., Lewis, S.R., and Cook, T.M. (2014). Tracheal intubation with a flexible intubation scope versus other intubation techniques for obese patients requiring general anaesthesia. Cochrane Database Syst. Rev., CD010320.","DOI":"10.1002\/14651858.CD010320.pub2"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.3906\/sag-1901-169","article-title":"Tracheal intubation with the McGrath MAC X-blade videolaryngoscope in morbidly obese and nonobese patients","volume":"49","author":"Arslan","year":"2019","journal-title":"Turk. J. Med. Sci."},{"key":"ref_3","first-page":"382","article-title":"Airway management in obese patient","volume":"80","author":"Langeron","year":"2014","journal-title":"Minerva Anestesiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Prathep, S., Jitpakdee, W., Woraathasin, W., and Oofuvong, M. (2022). Predicting difficult laryngoscopy in morbidly obese Thai patients by ultrasound measurement of distance from skin to epiglottis: A prospective observational study. BMC Anesthesiol., 22.","DOI":"10.1186\/s12871-022-01685-7"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1111\/j.1399-6576.2012.02693.x","article-title":"Intubation of the morbidly obese patient: GlideScope(\u00ae) vs. Fastrach\u2122","volume":"56","author":"Ydemann","year":"2012","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S444","DOI":"10.1161\/CIR.0000000000000261","article-title":"Part 7: Adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"132","author":"Link","year":"2015","journal-title":"Circulation"},{"key":"ref_7","first-page":"85","article-title":"Video laryngoscopy for endotracheal intubation of adult patients with suspected\/confirmed COVID-19. A systematic review and meta-analysis of randomized controlled trials","volume":"5","author":"Ludwin","year":"2020","journal-title":"Disaster Emerg. Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/j.1460-9592.2009.03026.x","article-title":"How did the Macintosh laryngoscope become so popular?","volume":"19","author":"Scott","year":"2009","journal-title":"Pediatr. Anesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e32046","DOI":"10.1097\/MD.0000000000032046","article-title":"A comparison of face-to-face endotracheal intubation and standard intubation using Airtraq video laryngoscope in morbidly obese patients: A randomized controlled trial","volume":"101","author":"Gaszynski","year":"2022","journal-title":"Medicine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100871","DOI":"10.1016\/j.accpm.2021.100871","article-title":"Improvement of glottis visualisation during video laryngoscopy by lifting a flopy epiglottis similarly to direct laryngoscopy with a Miller blade","volume":"40","author":"Chen","year":"2021","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e38507","DOI":"10.5812\/aapm.38507","article-title":"The use of a stylet to aid the lifting of the epiglottis with a video laryngoscope","volume":"6","author":"Ueda","year":"2016","journal-title":"Anesthesiol. Pain Med."},{"key":"ref_12","first-page":"1","article-title":"Videolaryngoscopy versus direct laryngoscopy in obese surgical patients. Step by step toward more convincing evidence","volume":"2","author":"Carron","year":"2022","journal-title":"J. Anesthesiol. Res. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jclinane.2017.11.008","article-title":"Videolaryngoscope versus Macintosh laryngoscope for tracheal intubation in adut with obesity: A systemic review and meta-analysis","volume":"44","author":"Hoshjima","year":"2018","journal-title":"J. Clin. Anesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"110216","DOI":"10.1016\/j.jclinane.2021.110216","article-title":"Videoalaryngoscopy versus direct laryngoscopy for tracheal intubation in obese adults: A meta-analysis","volume":"71","author":"Carron","year":"2021","journal-title":"J. Clin. Anesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3327","DOI":"10.1007\/s11695-021-05357-2","article-title":"Videolaryngoscopy Versus Direct Laryngoscopy for Patients with Obesity Requring Tracheal Intubation: A Meta-analysis","volume":"31","author":"Carron","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"170","DOI":"10.4103\/0019-5049.111846","article-title":"Comparison of glottic visualisation and ease of intubation with different laryngoscope blades","volume":"57","author":"Kulkarni","year":"2013","journal-title":"Indian J. Anaesth."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Moritz, A., Holzhauser, L., Fuchte, T., Kremer, S., Schmidt, J., and Irouschek, A. (2021). Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0250369"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jclinane.2016.01.032","article-title":"Airway risk factors for the Miller laryngoscope blade","volume":"33","author":"Landry","year":"2016","journal-title":"J. Clin. Anesth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/BF03013137","article-title":"Assessment of laryngeal view: Percentage of glottic opening score vs Cormack and Lehane grading","volume":"46","author":"Ochroch","year":"1999","journal-title":"Can. J. Anaesth."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1080\/10903120590924663","article-title":"Reliability of paramedic ratings of laryngoscopic views during endotracheal intubation","volume":"9","author":"Pinchalk","year":"2005","journal-title":"Prehospital Emerg. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1111\/j.1553-2712.1998.tb02823.x","article-title":"Assessment of airway visualization: Validation of the percentage of glottic opening (POGO) scale","volume":"5","author":"Levitan","year":"1998","journal-title":"Acad. Emerg. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"47","DOI":"10.4097\/kja.22268","article-title":"Ramped versus sniffing position in the videolaryngoscopy-guided tracheal intubation of morbidly obese patients: A prospective randomized study","volume":"76","author":"Lee","year":"2023","journal-title":"Korean J. Anesthesiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1093\/bja\/aeu077","article-title":"Are the obese difficult to intubate?","volume":"112","author":"Dixit","year":"2014","journal-title":"Br. J. Anaesth."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1007\/s00540-020-02835-2","article-title":"Effect of an aerosol box on tracheal intubation difficulty","volume":"34","author":"Wakabayashi","year":"2020","journal-title":"J. Anesth."},{"key":"ref_25","first-page":"717","article-title":"View of the larynx obtained using the Miller blade and paraglossal approach, compared to that with the Macintosh blade","volume":"36","author":"Achen","year":"2008","journal-title":"Intensiv. Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/BF03021064","article-title":"Straight blades improve visualization of the larynx while curved blades increase ease of intubation: A comparison of the Macintosh, Miller, McCoy, Belscope and Lee-Fiberview blades","volume":"50","author":"Arino","year":"2003","journal-title":"Can. J. Anaesth."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/0952-8180(95)00198-0","article-title":"Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation","volume":"8","author":"Benumof","year":"1996","journal-title":"J. Clin. Anesth."},{"key":"ref_28","first-page":"586","article-title":"McGrath Video Laryngoscope Versus Macintosh Direct Laryngoscopy for Intubation of Morbidly Obese Patients: A Randomized Trial","volume":"131","author":"Ruetzler","year":"2020","journal-title":"Obstet. Anesth. Dig."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/3\/681\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:48:42Z","timestamp":1760104122000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/3\/681"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,24]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["jcm13030681"],"URL":"https:\/\/doi.org\/10.3390\/jcm13030681","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,24]]}}}