You are sent to investigate an increased incidence of difficult endotracheal intubations in a mission hospital in Africa. On the first morning you are there, you observe an anesthesiologist giving a general anesthetic to a patient for an elective cesarean section. A rapid sequence induction with etomidate and succinylcholine is followed by the insertion of a MacIntosh blade #3 inserted into the mouth and larynx using the left hand. What follows then is contra to everything you have ever seen before. The anesthesiologist, instead of placing the endotracheal tube (ETT) to the right of the blade and into the trachea, places his right hand over the left hand and guides the ETT successfully into the trachea. You are amazed, but after careful inspection of the blade you understand the reason for this unorthodox way of placing the ETT in the trachea
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