McCoy blade is known to help in difficult intubation by lifting difficult to lift epiglottis but not for limited mouth opening. We found this blade useful for limited mouth opening as well. A 30-year male of road side accident was posted for surgery of fracture clavicle with mouth opening 2 cm due to fracture of zygomatic arch and maxilla. We decided to perform check laryngoscopy under topical anesthesia of the airway. With the limited interincisor gap of 2 cm, we were not sure whether we will be able to insert any of our available laryngoscope blades (Macintosh and McCoy) as the cut-off of interincisor gap is 3 cm. So, we carried out a thorough measurement of both the blades and found that the McCoy blade (Penlon manufacturer) was sleeker than the Macintosh blade (Penlon manufacturer; 1.6 cm of Macintosh versus 1.2 cm of McCoy at tip and 2.2 cm of Macintosh versus 1.5 cm of McCoy at handle side) [Figures 1 and 2]; and thus, we decided to try check laryngoscopy with McCoy blade.
Figure 1
Showing measurements at tip
Figure 2
Showing measurements at handle side
Showing measurements at tipShowing measurements at handle sideAirway was anesthetized with 10% lignocain spray (five puffs over 1 min). McCoy blade could be inserted with ease and the epiglottis could be visualized and lifted with gentle traction and only slight discomfort to the patient. Injection glycopyrrolate and fentanyl were administered intravenously (IV) and patient was anesthetized with IV propofol. After check ventilation, succinylcholine was given. Laryngoscopy was done with McCoy Laryngoscope and grade II Cormack–Lehane was observed and trachea was intubated successfully.McCoy laryngoscope is used in patients when difficulty in elevating epiglottis is encountered and activation of blade tip elevates the epiglottis and visualization of vocal cords.[1] We used it because of limited mouth opening after realizing that it is 4 mm sleeker than the Macintosh blade at the tip and 7 mm at the handle end. We looked up the literature to find out if this is true for all brands of these blades, but it is not mentioned in literature.We wish to highlight that McCoy blade can bring down the cut-off for intercisor gap needed for successful intubation and can serve as a boon in patients with limited mouth opening. It may be worth measuring the dimensions of all your laryngoscope blades, and especially the McCoy blades while planning to manage the airway of a patient with limited mouth opening.
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Figure 2