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Assessment of patient position for fiberoptic intubation using videolaryngoscopy
G D Shorten1, H H Ali, J T Roberts
1Department of Anesthesia, Massachusetts General Hospital, Boston 02114, USA.
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.