• G D Shorten, H H Ali, and J T Roberts.
• Department of Anesthesia, Massachusetts General Hospital, Boston 02114, USA.
• J Clin Anesth. 1995 Feb 1; 7 (1): 31-4.

Study ObjectiveTo compare laryngoscopic appearance obtained during flexible fiberoptic laryngoscopy with the patient's atlanto-occipital joint in the neutral and extended positions.DesignControlled clinical trial with each patient (in the neutral position) acting as his or her own control.SettingUniversity teaching hospital.Patients20 adult ASA physical status I and II patients, without anatomical airway abnormalities, undergoing elective surgical procedures.InterventionsFiberoptic laryngoscopy was performed on each patient with his or her atlanto-occipital joint in the neutral and extended positions.Measurements And Main ResultsPhotographs 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.ConclusionAtlanto-occipital extension is a useful maneuver during attempted fiberoptic intubation.

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