Ain-Shams Journal of Anaesthesiology

LETTER TO EDITOR
Year
: 2016  |  Volume : 9  |  Issue : 2  |  Page : 316-

Magill's forceps-shaped stylet: An aid to difficult intubation


Ravindra R Bhat1, Gayatri Mishra2, Sandeep K Mishra3, Satyen Parida3,  
1 Department of Anesthesiology & Critical Care, IGMCRI, Pondicherry, India
2 Department of Anesthesiology & Critical Care, MGMCRI, Pondicherry, India
3 Department of Anesthesiology & Critical Care, JIPMER, Pondicherry, India

Correspondence Address:
Sandeep K Mishra
Department of Anesthesiology & Critical Care, JIPMER, Pondicherry 605006
India




How to cite this article:
Bhat RR, Mishra G, Mishra SK, Parida S. Magill's forceps-shaped stylet: An aid to difficult intubation.Ain-Shams J Anaesthesiol 2016;9:316-316


How to cite this URL:
Bhat RR, Mishra G, Mishra SK, Parida S. Magill's forceps-shaped stylet: An aid to difficult intubation. Ain-Shams J Anaesthesiol [serial online] 2016 [cited 2021 Nov 29 ];9:316-316
Available from: http://www.asja.eg.net/text.asp?2016/9/2/316/182292


Full Text

Sir Ivan W. Magill [1] first described the use of forceps to advance the endotracheal tube into the larynx during direct laryngoscopy. Subsequently, Magill's forceps have been widely used as an aid to nasotracheal intubation [2], nasogastric tube insertion, insertion and removal of throat packs, removal of foreign bodies from the pharynx, and orotracheal intubation in Cormack-Lehane (C and L) grades 3 and 4 views. The design of the Magill's forceps enables the operator to use the laryngoscope with the left hand and employ the forceps in the right hand for any manipulations. The angulations of the forceps enable proper alignment of the operator's line of vision with the manipulation attempt, keeping the handle out of sight.

In certain situations, the laryngoscope blade cannot be moved toward the left side to deviate the tongue out of the line of vision to visualize the glottis (e.g. a mass in the left side of the oropharynx, such as nasopharyngeal carcinoma invading the oral cavity, left maxillary growth, etc.). In such situations, intubation with or without the aid of a stylet may be required, which might impede visualization of the glottis. Under these circumstances, where overall working space for the operator is significantly reduced, we tend to 'preform' the styletted endotracheal tube into a shape closely mimicking the curve of the Magill's forceps, as depicted in [Figure 1]. This effectively takes the endotracheal tube away from the line of visualization of the operator during advancement, thus facilitating intubation. Prior lubrication of the stylet helps in easy passage through the endotracheal tube and also smooth withdrawal following successful intubation. Apart from the situations enlisted above, a routine use of the Magill's forceps-shaped styletted tubes act as an aid to difficult intubation by not encroaching upon the line of vision of the anesthesiologist. In fact, some authors have actually found the Magill's forceps more beneficial than the stylet for orotracheal intubation in difficult airways [3]. However, they have not mentioned the shape into which the stylet was molded (frame into shaping) before attempting laryngoscopy. Intubation with the stylet would become a lot easier if the stylet-tube unit is molded into a shape simulating the angle of the Magill's forceps, as we have described here.{Figure 1}

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Conflicts of interest

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References

1Magill IW. Forceps for intratracheal anaesthesia. Br Med J 1920; 2:670.
2Rowbotham S. Intratracheal anaesthesia by the nasal route for operations on the mouth and lips. Br Med J 1920; 2:590-591,
3Arshad Z, Abbas H, Gupta L, Bogra J. Magill forceps - an aid for difficult intubation. Internet J Anesthesiol 2013; 31:1.