I'm an SRNA with a little more than a year left in school, and I'm here seeking some advice with intubation technique. I started out, as did the majority of my class, using the Mac blade for intubations. Most preceptors advised me to become competent with the Mac blade, and then transition to the Miller blade. At this point I am pretty comfortable with the Mac blade. The majority of intubations go smoothly, however, it seems like every 25th case or so I run in to the same problem. Its always the same problem, and I'm not sure how to fix it.
The problem is that as I enter the posterior oropharynx and lift up, I will have a great view of the entire epiglottis, completely covering the cords. My first inclination is to go deeper in to the vallecula and lift again, but for some reason this often does not work. I then apply cricoid pressure, and at that point I might have a grade III view, of just the most posterior aspect of the aretynoids. I can maybe sneak an Eshmann through and save the intubation, but sometimes not. A lot of times when this happens, it is not on patients who appear to be anterior, or whom I would expect to have difficulty with their airway. I have yet to find a solution for the scenario of blade in vallecula, epiglottis completely obstructing view. This happened to me yesterday on an African American 6', 240lbs patient, with a mallampati 2. I was using a Mac 4, and repositioned the blade as deep as I could once I saw the epiglottis was obstructing my view. I'm just not sure what else to do besides reposition the blade, and/or use cricoid pressure.
The thought that keeps coming in to my head when this happens is: "I wish I could directly lift the epiglottis." This leads me to think that perhaps I would avoid this situation with a Miller blade. Has anyone had a similar experience? Is this one of the limitations of the Mac blade, or is it just a limitation of the person wielding it? Should I try to transition to the Miller blade to avoid this scenario? Any tips appreciated.