The Difficult Airway

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Atlanto-Occipital Movement

The atlanto-occipital movement can be commonly known as the "deep sniff" position.  Determining head movement with this flexion of the neck to the chest and extension at the atlanto-occipital joint can be an early indication of a difficult airway.  A decreased atlanto-occipital movement can create an obstructed view as the laryngeal / pharyngeal axes are not aligned causing the larynx to remain more anterior.  When a head-tilt chin-lift maneuver is performed and there is limited atlanto-occipital movement, the patient may also be difficult to ventilate.  [2, 42]

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