Direct laryngoscopy is carried out (usually) with thepatientlying on his or her back; the laryngoscope is inserted into themouthon the right side and flipped to the left to trap and move thetongueout of the line of sight, and, depending on the type of blade used, inserted either anterior or posterior to theepiglottisand then lifted with an upwards and forward motion ("away from you and towards the roof "). This move makes a view of theglottispossible. This procedure is done in an operation theatre with full preparation for resuscitative measures to deal with respiratory distress. There are at least ten different types of laryngoscope used for this procedure, each of which has a specialized use for the otolaryngologist and medical speech pathologist. This procedure is most often employed by anaesthetists for endotracheal intubation under general anaesthesia, but also in direct diagnostic laryngoscopy with biopsy. It is extremely uncomfortable and is not typically performed onconsciouspatients, or on patients with an intactgag reflex.