1. Flex & Retroflex

2. Rotate right & Rotate left

3. Advance & Withdraw

Doing so ensures that any left/right rotation of the scope body will translate into the same right/left rotation of the scope tip (i.e. and thus the view on the screen in front of you)

It will improve your view, maintain oral airway patency, and protect your scope from biting teeth 

If the vocal cords are centered on your screen, they are centered beneath your scope

Maximizes oropharyngeal space AND encourages the oral airway to stay in the mouth and in the midline.

Deep inspiration/sniff will open the vocal cords (useful with railroading the ETT)

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Any other scope manipulations will not produce predictable movements of the distal end of the scope.

For our shorter colleagues, achieving this may require a low OR table and/or step stools

Ask the patient to bite gently on the oral airway. This prevents it from popping out, which invariably always forces the oral airway off the midline.

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A crooked oral airway guides your scope lateral and AWAY from the cords. Best case scenario, this is frustrating. Worst case, the whole procedure risks failure.

Coughing will elevate the larynx. Aiming scope for the anterior commissure of cords will ultimately center the scope with coughing