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.