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A shoulder roll is often useful when anaesthetising infants to help achieve optimal positioning for tracheal intubation. It is used to elevate the shoulders of infants with large occiputs, and is particularly useful for infants with hydrocephalus. A rolled-up towel may be used as a shoulder roll. However, we have found that a more stable position may be achieved with fibre Meditainer trays (Omni-pac, Hamburg, Germany) placed face down under the shoulders. The trays are firm yet slightly malleable. One tray face down may be of adequate height to elevate the shoulders to achieve a neutral head position (the height of one tray is approximately 21 mm). To achieve a higher shoulder position, the trays may be stacked face down. We would not advocate keeping the fibre trays in place after intubation of the trachea is complete, as there is a risk of prolonged pressure to the skin overlying the infant’s scapula.
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