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Direct laryngoscopy is critically dependent on head positioning. Many practitioners release the extended head while they reach for the laryngoscope and endotracheal tube (ETT). This results in the head slipping back into a suboptimal neutral position and as a result losing the ideal "sniffing the morning air" position.
In this technique the awake patient is instructed to assume the optimal head position or as close to it as tolerated. The anaesthetic is commenced and mask ventilation started. The left hand holds the mask firmly to the patient's face with the little finger behind the angle...