Assessment of patient position for fiberoptic intubation using videolaryngoscopy

Study Objective: To compare laryngoscopic appearance obtained during flexible fiberoptic laryngoscopy with the patient's atlanto-occipital joint in the neutral and extended positions. Design: Controlled clinical trial with each patient (in the neutral position) acting as his or her own control. Setting: University teaching hospital. Patients: 20 adult ASA physical status I and II patients, without anatomical airway abnormalities, undergoing elective surgical procedures. Interventions: Fiberoptic laryngoscopy was performed on each patient with his or her atlanto-occipital joint in the neutral and extended positions. Measurements and Main Results: Photographs of the laryngoscopic appearances were graded on a scale of 1 to 4 by a blinded observer according to the proportion of the laryngeal inlet visible. Atlanto-occipital extension improved laryngoscopic appearance in 14 cases and produced no change in the remaining 6. Conclusion: Atlanto-occipital extension is a useful maneuver during attempted fiberoptic intubation. © 1995.