Simple method for obtaining the optimal laryngoscopic view in children: A prospective observational study

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Head and neck positioning has an important effect on laryngeal visualization during laryngoscopy. For small children and infants, a head-flat position is traditionally assumed; however, during laryngoscopy, the optimal head position may result in a superior laryngeal view in certain patients.


We investigated whether the alignment of the external auditory meatus and the sternal notch with a pillow with an individualized height is associated with improved laryngeal visualization during direct laryngoscopy in pediatric patients. We enrolled 49 pediatric patients (3 to 6 years old) receiving general anesthesia. The percentage of glottic opening score and ease of handling the laryngoscope (range 0–10) were recorded before and after head positioning with the pillow.


Most of the children, except two patients, needed a pillow beneath their head to align the external auditory meatus and the sternal notch. The percentage of glottic opening score was significantly higher after pillow adjustment compared to that in the neutral position (50 [20–80] vs. 90 [37.5–100]; p < 0.0001). Handling of the laryngoscope improved with pillow adjustment (7 [6.0–8.0] vs. 9 [8.0–10.0]; p < 0.0001). There were no significant complications during intubation.


Positioning of the head in order to align it with the external auditory meatus and sternal notch was associated with superior laryngoscopic visualization in pediatric patients. This resulted, in a more straightforward laryngoscopic procedure.

Trial registrations identifier: KCT 0001156

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