Plan A - Initial Intubation Plan

The first attempt at intubation should be carried out after the following optimal conditions have been achieved, if possible:

• Adequate anaesthesia with muscle relaxation
• Head extended and neck flexed in the ‘sniffing the morning air’ position, shown in Fig 1
• Optimum external laryngeal manipulation (OELM) or backward upward rightward pressure (BURP) on the thyroid cartilage, shown in Fig 2

An adequate view of the larynx is important to achieve at this point.