The Cormack-Lehane (C-L) grading classifies laryngoscopic view. A grade III view (only the epiglottis visible, no glottis seen) is obtained on direct laryngoscopy. The BEST device to improve visualisation and achieve successful intubation is:
- A McCoy levering laryngoscope with the lever tip activated
- B Bougie (gum elastic bougie) combined with existing direct laryngoscopy
- C Hyperangulated video laryngoscope (e.g., C-MAC D-blade or McGrath MAC) ✓
- D Blind nasal intubation by feel of breath sounds
Explanation
A C-L grade III view (epiglottis only visible) represents a significantly difficult airway. Hyperangulated video laryngoscopes (Storz C-MAC D-blade, McGrath MAC, GlideScope Ranger) provide a markedly better view around the oropharyngeal curve because the camera tip has an acute angle that allows visualisation of the glottis even when direct line-of-sight is impossible. For grade III, the hyperangulated video laryngoscope converts most cases to a grade I view. A gum elastic bougie combined with direct laryngoscopy is useful for grade IIb-III but is a second-line option when video is available. McCoy laryngoscope helps grade IIb but rarely converts grade III to success.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.