The McCoy straight blade does not improve laryngoscope and intubation in normal infants

Purpose: The McCoy curved blade laryngoscope has been demonstrated to improve view at laryngoscopy in adults. A straight-bladed version of this laryngoscope has recently been introduced into pediatric practice. The objective of this prospective, randomized study was to compare the intubating conditions afforded by the McCoy (#1) straight blade laryngoscope with the conventional Miller (#1) blade in neonates and infants. Methods: Forty patients under six months of age, were randomized into two groups: one group (n = 20) had an initial laryngoscopy with the McCoy blade and then had a laryngoscopy and subsequent intubaton using the Miller blade; the second group (n = 20) had an initial laryngoscopy with the Miller blade, followed by laryngoscopy and intubation using the McCoy blade. All intubations were performed by one anesthesiologist familiar with using both blades. Results: The majority of patients (39 out of 40) had a similar or superior view (Cormack and Lehane classification) with the Miller when compared with the McCoy laryngoscope. Mean time to laryngoscopy was 14.9 (12.7) sec with the McCoy and 6.8 (2.07) sec with the Miller blade (P = 0.001), whereas mean time to intubation was 25.13 (10.4) sec with the McCoy and 12 (8.5) sec with the Miller blade (P = 0.014). There was no difference between the groups regarding desaturation and changes in heart rate during laryngoscopy and intubation. Conclusion: Our data indicate that the McCoy blade has no advantage over the conventional pediatric Miller blade in normal infants.