Magill Forceps- An Aid For Difficult Intubation

Abstract

The Magill forceps are used for nasotracheal intubation, endotracheal suctioning, passing gastric tubes, placement of tampons in the nasopharynx and extraction of foreign material from the pharynx. On many occasions they used it for other anesthesia and extra-anesthesia purposes; e.g. removal of mucous plugs, solid food particles in case of vomiting on induction, fallen loose tooth in the mouth and impacted bolus of meat. Even Ascaris worm obstructing the airway and the list would not end.Although Magill forceps are being used as an aid for nasotracheal intubation since last so many years but its use as an aid to orotracheal intubation is not described. In cases with difficult airway, in which laryngoscopic view is Cormack Lehane Grading is II/III some time we require use of a stylet as an assistance. In such situation with the use of stylet we find some problems. Therefore the aim of this study is to find out whether we can use Magill forceps as an aid for difficult intubation in place of stylet. INTRODUCTION The Nasal tracheal intubation was first described in 1920 by Stanley Rowbotham and Ivan Magill. They developed a device to aid the insertion of the tip of the endotracheal tube into the glottis. Magill's forceps are still the instrument of choice for nasal tracheal intubation carried out under laryngoscopic visualization. This is a valuable instrument for Anesthesiologists to help introducing the endotracheal tube into the larynx. The Magill forceps are used for nasotracheal intubation, endotracheal suctioning, passing gastric tubes, placement of tampons in the nasopharynx and extraction of foreign material from the pharynx. On many occasions they used it for other anesthesia and extra-anesthesia purposes; e.g. removal of mucous plugs, solid food particles in case of vomiting on induction, fallen loose tooth in the mouth and impacted bolus of meat. Even Ascaris worm obstructing the airway and the list would not end. Although Magill forceps are being used as an aid for nasotracheal intubation since last so many years but its use as an aid to orotracheal intubation is not described. In cases with difficult airway, in which laryngoscopic view is Cormack Lehane Grading is II/III some time we require use of a stylet as an assistance. In such situation with the use of stylet we find the following problemsTherefore the aim of this study is to find out whether can we use Magill forceps as an aid for difficult intubation in place of stylet. MATERIALS AND METHODS We have studied 50 patients of either sex with no age limit. The only criteria was the laryngoscopic view CL II/III in which there is requirement of extra aid or manoeuvre to intubate the trachea (in the form of stylet or cricoid pressure). The patients were randomised equally to intubate either with the aid of Stylet or Magill forcep. In Magill forecp group, we putted Magill forcep and pushed endotracheal tube in the trachea. Then we hold the tube just above the cuff with the help of Magill forceps and forward it in to trachea. In another group of 25 patients we used stylet when required. We found Magill very useful especially when there is limited mouth opening. Further, there was less chances of trauma and also technically easy as compared to stylet. MAGILL FORCEPS Magill forceps are angled forceps used to guide the endotracheal tube into the laryngeal inlet during nasotracheal intubation or a nasogastric tube into the esophagus under direct vision. It is also used to place pharyngeal packs and removal of foreign bodies. Magill ForcepsAn Aid For Difficult Intubation 2 of 4 Figure 1 Fig. 1. Figure showing Magill Forceps STATISTICAL ANALYSIS The continuous data were summarised as Mean ± SD while discern (categorical) in %. The continuous variables of two independent groups were compared by independent Student’s t test while discrete variables by Fisher test. A two-sided (α=2) p<0.05 was considered statistically significant.