Intubating with mac 3 or Mac 4, or left hand

[prolene60]

Which intubation method/blade gives you your personal high success rate?( For adults) Do you use a Mac 3, a Mac 4, or a Miller? Is there a reason why? Do you sweep the tongue or just put the blade in midline? Also I'm wondering if one's own left hand in place of a blade with a good overhead light is better at controlling and lifting the tongue and epiglottis than any other blade.

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[EM4life]

Prefer a Miller 4, will always have a Mac 4 as back up (esp in case of big fat tongue people), but my success rate with a miller 4 is probably >95%, then alternatively, if all that fails - goto glidescope/bougie. Of course this will change depending on why you are tubing the patient and anatomy of the patient - and no I do not think your left hand will be better at controlling and lifting the tongue and epiglottis. There are some who will do finger intubations but I can't say I've had good luck with that when we've practiced on cadavers - I think if you like have marfans or have super long fingers this might work, but mine are too short for that 😛

 

[alpinism]

Mac 4 w tongue sweep baby.

Worked 3x tonight.

Hmm I'll stick to a laryngoscope and bougie instead of my fingers.

 

[Venko]

Which intubation method/blade gives you your personal high success rate?( For adults) Do you use a Mac 3, a Mac 4, or a Miller? Is there a reason why? Do you sweep the tongue or just put the blade in midline? Also I'm wondering if one's own left hand in place of a blade with a good overhead light is better at controlling and lifting the tongue and epiglottis than any other blade.

I can intubate with either blade style (as a learner i alternated calendar month with type of blade i would use, so that i became equally comfortable with both styles - HIGHLY RECOMMEND) and the size, which matters most with Mac style, is dependent on the patient. A miller 3 can intubate nearly anyone.

Regarding manual intubations, they are not in the same ballpark of success because of the inferior lighting, the slippery nature of the environment and the potential for body fluid exposure if the patient bites you or aspirated something sharp. Also the mechanics of replacing your blade with a hand is awkward unless you do a purely tactile intubation and these are not easy.

 

[Rendar5]

I've tried a manual intubation only once, it is a very slippery intubation. Prefer never to try again. I'm a mac guy (I honestly prefer to have the epiglottis available as a landmark for a bougie if I get a grade III or worse view), and practice honestly makes perfect. The size of the Mac is dependent on the size of the patient's airway anatomy. I could never get used to a Miller, and only use it to intubate peds (which is rare) and when a resident is using it and fails 2 tries.

 

[Doctor Bob]

I start with a Mac4 on pretty much everyone... I can always pull the blade back if the vallecula isn't very deep, but I can only push a Mac3 in so far.

But like Venko I forced myself to alternate between mac and miller during training (for the first year I alternated between which I started with, then during 2nd year I added glidescope into the rotation...)

 

[Apollyon]

Prefer a Miller 4, will always have a Mac 4 as back up (esp in case of big fat tongue people), but my success rate with a miller 4 is probably >95%, then alternatively, if all that fails - goto glidescope/bougie. Of course this will change depending on why you are tubing the patient and anatomy of the patient - and no I do not think your left hand will be better at controlling and lifting the tongue and epiglottis. There are some who will do finger intubations but I can't say I've had good luck with that when we've practiced on cadavers - I think if you like have marfans or have super long fingers this might work, but mine are too short for that 😛

Do you mean "Excalibur"?

 

[dotcb]

My go to 1st approach is a Glide#3 blade (it's what I'm best with).

If I want to practice DL, I use a Mac 4.

I think the party line is - use the shortest blade that's long enough. The longer the blade, the more torque and work you put on your wrist & hand. For this reason, a shorter blade is better. I just learned with a Mac #4, and for this reason, I'd rather have the extra blade length there if I need it. Hold the laryngoscope handle down low to minimize torque.

 

[EM4life]

Do you mean "Excalibur"?

Yes yes I do. It's go big or go home, sometimes I find that I am looking in the right main stem 😀

 

[Bostonredsox]

man or large female -> mac 4
normal female -> mac 3
backup with pocket bougie
this is of course if you dont have a glide, cmac or some other VL device

i detest millers.