title: Simple method for obtaining the optimal laryngoscopic view in children: A prospective observational study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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 6years 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  http://cris.nih.go.kr identifier: KCT 0001156.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
authors.forename: Eun-Hee
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
authors.forename: Sang-Hwan
authors.initials: SH
authors.lastname: Ji
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
authors.forename: In-Kyung
authors.initials: IK
authors.lastname: Song
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
authors.forename: Jin-Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea. Electronic address: dami0605@snu.ac.kr.
authors.forename: Hee-Soo
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D005260:Female; D005931:Glottis; D006257:Head / Q000000981:diagnostic imaging; D006801:Humans; D007828:Laryngoscopy; D007830:Larynx / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D011446:Prospective Studies; D056910:Republic of Korea
keywords: Children; Head position; Laryngoscopy