scholarly journals Comparison of sniffing position and simple head extension for visualization of glottis during direct laryngoscopy.

2012 ◽  
Vol 9 (1) ◽  
pp. 58-63 ◽  
Author(s):  
B Bhattarai ◽  
S K Shrestha ◽  
S Kandel
Keyword(s):  
Tracheal Intubation ◽  
Direct Laryngoscopy ◽  
Elective Surgery ◽  
Demographic Profiles ◽  
Intubation Difficulty ◽  
Ideal Position ◽  
Head Extension ◽  
Extension Group ◽  
Difficulty Scale ◽  
Difficulty Score

Background The ability of good glottis visualization during direct laryngoscopy is major determinant of easy tracheal intubation. Sniffing position for laryngoscopy is considered as gold standard and ideal position. Several studies have questioned the validation of sniffing potion. Objectives This study aims to compare relative efficacy of sniffing position and simple head extension for visualization of glottis during direct laryngoscopy. Methods Four hundred patients undergoing elective surgery under general anesthesia requiring endotracheal intubation were randomized into two groups and study was concluded. Glottic visualization was assessed using modified Cormack and Lehane classification. After laryngoscopy, tracheal intubation was performed and intubation difficulty scale was noted. Results Both the groups were comparable regarding glottis visualization. Both the groups were comparable in demographic profiles. All the intubation difficulty scale variables were comparable in both the groups except N3. Total Intubation Difficulty Score was better in sniffing position than in simple head extension group. Conclusion Glottic visualization and intubation difficulty score was better in sniffing position as compared to simple head extension.http://dx.doi.org/10.3126/kumj.v9i1.6265 Kathmandu Univ Med J 2011;9(1):58-63

scholarly journals Comparative Evaluation of the Sniffing Position with Simple Head Extension for Laryngoscopic View and Intubation Difficulty in Adults Undergoing Elective Surgery

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Smita Prakash ◽  
Amy G. Rapsang ◽  
Saurabh Mahajan ◽  
Shameek Bhattacharjee ◽  
Rajvir Singh ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Randomized Study ◽  
Simple Extension ◽  
Upright Stance ◽  
Laryngoscopic View ◽  
Intubation Difficulty ◽  
Lifting Force ◽  
Head Extension ◽  
Extension Group ◽  
Position Group

The effect of patient position on mask ventilation, laryngoscopic view, intubation difficulty, and the stance adopted by the anesthesiologist during laryngoscopy and tracheal intubation was investigated in 546 anesthetized adults in this prospective, randomized study. Patients were randomly assigned to either the sniffing position group or the simple extension group. The distribution of Cormack grades was comparable between the two groups (P=0.144). The IDS score [median (IQR)] was 0 (0–2) in the sniffing group and 1 (0–2) in the simple extension group;P=0.002. There were significant differences between groups with regard to intensity of lifting force, external laryngeal manipulation, alternate techniques used, number of attempts, and the stance adopted by anesthesiologist. We conclude that the sniffing position is superior to simple head extension with regard to ease of intubation as assessed by IDS. An upright stance is adopted by more anesthesiologists performing intubation with patients in the sniffing position.

scholarly journals Short Neck, a new criterion for airway assessment A pilot, cohort single blind study

2020 ◽  
Author(s):  
jafar faraj ◽  
Yasir E. Ahmed ◽  
Chetankumar B. Raval ◽  
Taisir M Yousif ◽  
Neeraj Kumar ◽  
...  
Keyword(s):  
Elective Surgery ◽  
P Value ◽  
Short Neck ◽  
Neck Length ◽  
Intubation Difficulty ◽  
Airway Assessment ◽  
Difficulty Scale ◽  
Group B ◽  
Difficulty Score ◽  
New Criterion

Abstract Purpose Short Neck is a term used by anesthesiologists to describe one of the risk factors for difficult airway management. However, the term Short Neck is very subjective and has not been standardized. We attempt to quantify Short Neck.Methods A pilot prospective single blinded study was conducted at Hamad General Hospital, Doha, Qatar between March 2018 and October 2018. 97 adult patients scheduled for elective surgery under general anesthesia were recruited. Measurements of airway assessment, including neck length, were documented prior to anesthesia. The operators (anesthesiologists) were blinded. Intubation Difficulty Scale was used. All data were documented and analysed afterwards. Patients were of three groups according to Intubation Difficulty Scale (IDS): Group A: IDS 0, Group B: IDS >0 - ≤5 and Group C: IDS >5.Results Five patients (5.2%) with intubation difficulty score >5 have a mean neck length 7.6 cm. Short Neck was found to have a significant p value 0.022 within the three groups.Conclusions Patient's features relevant to airway assessment are rather difficult to quantify. This is the first reported attempt to obtain an objective value for Short Neck in routine airway assessment.

scholarly journals Comparison of Laryngoscopic Views between C-MAC™ and Conventional Laryngoscopy in Patients with Multiple Preoperative Prognostic Criteria of Difficult Intubation. An Observational Cross-Sectional Study

Medicina ◽  
2019 ◽  
Vol 55 (12) ◽  
pp. 760
Author(s):  
Aikaterini Amaniti ◽  
Panagiota Papakonstantinou ◽  
Dimitrios Gkinas ◽  
Ioannis Dalakakis ◽  
Evangelia Papapostolou ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Difficult Intubation ◽  
Elective Surgery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cross Sectional Study ◽  
Laryngoscopic View ◽  
Cross Sectional ◽  
Intubation Difficulty ◽  
Difficulty Scale

Background and Objectives: Video laryngoscopy has been proven useful under difficult airway scenarios, but it is unclear whether anticipated improvement of visualization is related to specific difficult intubation prognostic factors. The present study evaluated the change in laryngoscopic view between conventional and C-MAC® laryngoscopy and the presence of multiple difficult intubation risk factors. Materials and Methods: Patients scheduled for elective surgery with >2 difficult intubation factors, (Mallampati, thyromental distance (TMD), interinscisor gap, buck teeth, upper lip bite test, cervical motility, body mass index (BMI)) were eligible. Patients underwent direct laryngoscopy (DL) followed by C-MAC™ laryngoscopy (VL) and intubation. Change of view between DL and VL, time for best view, intubation difficulty scale (IDS) and correlation between prognostic factors, laryngoscopic view improvement, and IDS were measured. Results: One-hundred and seventy-six patients completed the study. VL lead to fewer Cormarck–Lehane (C/L) III-IV, compared to DL (13.6% versus 54.6%, p < 0.001). The time to best view was also shorter (VL: 10.82 s, DL: 12.08 s, p = 0.19). Mallampati III-IV and TMD ≤ 6 cm were related to improvement of C/L between DL and VL. Logistic regression showed these two factors to be a significant risk factor of the glottis view change (p = 0.006, AUC-ROC = 0.57, 95% CI: 0.47–0.66). 175/176 patients were intubated with VL. 108/176 were graded as 0 < IDS ≤ 5 and 12/176 as IDS > 5. IDS was only correlated to the VL view (p < 0.0001). Conclusion: VL improved laryngoscopic view in patients with multiple factors of difficult intubation. Mallampati and TMD were related to the improved view. However, intubation difficulty was only related to the VL view and not to prognostic factors.

Endotracheal Intubation in Patients with Cervical Spine Immobilization

2007 ◽  
Vol 107 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Chrisen H. Maharaj ◽  
Elma Buckley ◽  
Brian H. Harte ◽  
John G. Laffey
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Cervical Spine ◽  
Tracheal Intubation ◽  
Controlled Clinical Trial ◽  
Randomized Controlled Clinical Trial ◽  
Intubation Difficulty ◽  
Randomized Controlled ◽  
Difficulty Scale ◽  
Single Use

Abstract Background: The Airtraq laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel single-use tracheal intubation device. The authors compared ease of intubation with the Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization in a randomized, controlled clinical trial. Methods: Forty consenting patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of four anesthesiologists experienced in the use of both laryngoscopes. Results: No significant differences in demographic or airway variables were observed between the groups. All but one patient, in the Macintosh group, were successfully intubated on the first attempt. The Airtraq reduced the duration of intubation attempts (mean ± SD: 13.2 ± 5.5 vs. 20.3 ± 12.2 s), the need for additional maneuvers, and the intubation difficulty scale score (0.1 ± 0.5 vs. 2.7 ± 2.5). Tracheal intubation with the Airtraq caused fewer alterations in blood pressure and heart rate. Conclusions: These findings demonstrate the utility of the Airtraq laryngoscope for tracheal intubation in patients with cervical spine immobilization.

Comparison between Sniffing Position and 25 Degree Backup Position in View of Glottis During Direct Laryngoscopy and Intubation - A Study from Mangalore, Karnataka

2021 ◽  
Vol 8 (41) ◽  
pp. 3573-3577
Author(s):  
AKhil Rao U.K. ◽  
Athira Soman ◽  
Anuradha Yadav ◽  
Yashwant R. ◽  
Sucheth Sharat
Keyword(s):  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Randomized Study ◽  
Group I ◽  
Head Positioning ◽  
Difficulty Scale ◽  
Group Ii

BACKGROUND Endotracheal intubation for the purpose of providing anaesthesia was first described by William Mc Ewan. Jackson1 stressed the importance of anterior flexion of the lower cervical spine, in addition to obvious extension of the atlanto-occipital joint. Sniffing position has been commonly advocated as a standard head positioning for direct laryngoscopy which is achieved by flexion of the neck on chest and extension of the head at the atlanto-occipital joint. Present study was designed to evaluate the glottis view and ease of intubation achieved with direct laryngoscopy in the sniffing position with that of 25 degree backup position in a study group of 100 patients divided in 2 groups of 50 each. METHODS This study is a controlled comparative study. Controlled trial in 50 consecutive patients in each group [Group I and Group II] was conducted on patients who underwent elective surgery under general anaesthesia. Inclusion Criteria - General anaesthesia with endotracheal intubation, Aged 18 to 60 years, American society of Anaesthesiologists (ASA) grades I and II. Exclusion Criteria - Patients with body mass index more than 30 kg/m2. 1. Bucked teeth. 2. Restricted neck movement. 3. Inter-incisor gap less than 35 mm. 4. Thyro-mental distance less than 6 mm. 5. Patients with risk of regurgitation and aspiration. 6. Pharyngeal pathology. 7. Limitation of anterior and posterior movement of mandible 8. Pregnant patients Groups wereGroup I – Sniffing position Group II– 25 degree back up position RESULTS The glottis visualization was assessed by Cormack Lehane grading which revealed that glottis view was better in 25 degree backup position than sniffing position. CONCLUSIONS In our prospective randomized study in a series of 50 patients undergoing general anaesthesia in SIMS & RC, intubation difficulty scale (IDS) score was better in 25 degree backup position than sniffing position. It implies glottis view is better in 25 degree backup position than sniffing position. KEYWORDS Sniffing Position, 25 Degree Backup Position, Laryngoscopy

scholarly journals Time to intubation with McGrath™ videolaryngoscope versus direct laryngoscope in powered air-purifying respirator: a randomised controlled trial

2021 ◽  
Author(s):  
QY Goh ◽  
SA Lie ◽  
Z Tan ◽  
PYB Tan ◽  
SY Ng ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Surgical Patients ◽  
Intubation Difficulty ◽  
Direct Laryngoscope ◽  
Significant Difference ◽  
Scale Scores ◽  
Difficulty Scale ◽  
Randomised Controlled

Introduction: During the COVID-19 pandemic, multiple guidelines have recommended the videolaryngoscope for tracheal intubation. However, there is no evidence that videolaryngoscope reduces time to tracheal intubation, which is important for COVID-19 patients with respiratory failure. Methods: To simulate intubation of COVID-19 patients, we randomised 28 elective surgical patients to be intubated with either the McGrath™ MAC videolaryngoscope or the direct laryngoscope by specialist anaesthetists donning 3M™ Jupiter™ powered air-purifying respirators (PAPR) and N95 masks. Primary outcome was time to intubation. Results: The median (IQR) times to intubation were 61s (37–63 s) and 41.5s (37–56 s) in the videolaryngoscope and direct laryngoscope groups respectively (p = 0.35). The closest mean (SD) distances between the anaesthetist and the patient during intubation were 21.6 cm (4.8 cm) and 17.6 cm (5.3 cm) in the videolaryngoscope and direct laryngoscope groups, respectively (p = 0.045). There were no significant differences in the median intubation difficulty scale scores, proportion of successful intubation at first laryngoscopic attempt and proportion of intubations requiring adjuncts. Intubations for all the patients were successful with no adverse event. Conclusion: There was no significant difference in the time to intubation by specialist anaesthetists who were donned in PAPR and N95 masks on elective surgical patients with either the McGrath™ videolaryngoscope or direct laryngoscope. The distance between the anaesthetist and patient was significantly further with the videolaryngoscope. The direct laryngoscope could be an equal alternative to videolaryngoscope for specialist anaesthetists when resources are limited or disrupted due to the pandemic.

scholarly journals Evaluation of Intubating Conditions during Direct Laryngoscopy using Sniffing Position and Simple Head Extension- A Randomised Clinical Trial

2021 ◽  
Author(s):  
Amanjot Singh ◽  
Rupinder Kaur ◽  
Gurpreet Singh ◽  
Kewal Krishan Gupta
Keyword(s):  
Clinical Trial ◽  
Tracheal Intubation ◽  
Direct Laryngoscopy ◽  
Randomised Clinical Trial ◽  
P Value ◽  
Group I ◽  
Head Extension ◽  
Number Of Patients ◽  
Lehane Grade ◽  
Group Ii

Introduction: Optimal laryngeal visualisation during direct laryngoscopy requires adequate positioning of the head and neck. Traditionally, Sniffing Position (SP) is the recommended position to provide superior glottic visualisation. However various studies in recent past have challenged the superiority of SP. Aim: To evaluate whether SP provides better glottic visualisation and ease of intubation {as assessed by total Intubation Difficulty Score (IDS) score as well as its individual components} compared to Simple Head Extension (SHE) during direct laryngoscopy and endotracheal intubation. Materials and Methods: The randomised clinical trial was conducted at GGS Medical College and Hospital, Faridkot, Punjab, India, from May 2019 to October 2020, on 220 patients. Patients undergoing elective surgeries under general anaesthesia were randomly divided into two groups. Laryngoscopy and tracheal intubation in Group I was done in SP, which was obtained by placing a non compressible pillow of height 8 cm under the patient’s head. Patients in Group II underwent laryngoscopy and tracheal intubation in SHE position. Glottic visualisation using modified Cormack and Lehane (CL) grades, IDS and sympathetic responses between the two groups were studied. The data was compared using student’s t-test and Chi-square test. Results: Cormack and Lehane Grade I was seen in 69 (62.7%) of patients in Group I as against 51(46.4%) of patients in Group II (p-value=0.015). Easy intubation (total IDS score=0) was seen in a greater number of patients in Group I (60.9%) as compared to Group II (40.95%) (p-value=0.003). Slight difficulty in intubation (total IDS score=1-5) was encountered in 50.0% of patients in group II (n=55) and 35.5% of patients in group I (n=39) (p-value=0.029). Conclusion: The present study concluded that use of SP resulted in better glottic visualisation and was associated with favourable intubation conditions as compared to SHE position.

Cricoid Pressure Does Not Increase the Rate of Failed Intubation by Direct Laryngoscopy in Adults

2005 ◽  
Vol 102 (2) ◽  
pp. 315-319 ◽  
Author(s):  
Alexis F. Turgeon ◽  
Pierre C. Nicole ◽  
Claude A. Trépanier ◽  
Sylvie Marcoux ◽  
Martin R. Lessard
Keyword(s):  
Scale Score ◽  
Direct Laryngoscopy ◽  
Cricoid Pressure ◽  
Anesthesia Induction ◽  
Intubation Time ◽  
Failed Intubation ◽  
Laryngoscopic View ◽  
Intubation Difficulty ◽  
Lehane Grade ◽  
Difficulty Scale

Background Cricoid pressure (CP) is applied during induction of anesthesia to prevent regurgitation of gastric content and pulmonary aspiration. However, it has been suggested that CP makes tracheal intubation more difficult. This double-blind randomized study evaluated the effect of CP on orotracheal intubation by direct laryngoscopy in adults. Methods Seven hundred adult patients undergoing general anesthesia for elective surgery were randomly assigned to have a standardized CP (n = 344) or a sham CP (n = 356) during laryngoscopy and intubation. After anesthesia induction and complete muscle relaxation, a 30-s period was allowed to complete intubation with a Macintosh No. 3 laryngoscope blade. The primary endpoint was the rate of failed intubation at 30 s. The secondary endpoints included the intubation time, the Cormack and Lehane grade of laryngoscopic view, and the Intubation Difficulty Scale score. Results Groups were similar for demographic data and risk factors for difficult intubation. The rates of failed intubation at 30 s were comparable for the two groups: 15 of 344 (4.4%) and 13 of 356 (3.7%) in the CP and sham CP groups, respectively (P = 0.70). The grades of laryngoscopic view and the Intubation Difficulty Scale score were also comparable. Median intubation time was slightly longer in the CP group than in the sham CP group (11.3 and 10.4 s, respectively, P = 0.001). Conclusions CP applied by trained personnel does not increase the rate of failed intubation. Hence CP should not be avoided for fear of increasing the difficulty of intubation when its use is indicated.

Evaluation of Tracheal Intubation Difficulty in Patients with Cervical Spine Immobilization 

1999 ◽  
Vol 91 (5) ◽  
pp. 1253-1253 ◽  
Author(s):  
Charles E. Smith ◽  
Anna B. Pinchak ◽  
Tejbir S. Sidhu ◽  
Brian P. Radesic ◽  
Alfred C. Pinchak ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Tracheal Intubation ◽  
Scale Score ◽  
Conventional Group ◽  
P Value ◽  
Success Rates ◽  
Intubation Difficulty ◽  
Fiberoptic Laryngoscope ◽  
Scale Scores ◽  
Difficulty Scale

Background The WuScope is a rigid, fiberoptic laryngoscope designed to facilitate tracheal intubation without the need for head extension. The study evaluated the WuScope in anesthetized patients with neck immobilization. Methods Patients were randomized to one of two groups: those receiving fiberoptic laryngoscopy (WuScope, n = 43) and those receiving conventional laryngoscopy (Macintosh blade, n = 44). Manual in-line stablization of the cervical spine was done during intubation. Seven parameters of intubation difficulty were measured (providing an intubation difficulty scale score): number of operators, number of attempts, number of techniques, Cormack view, lifting force, laryngeal pressure, and vocal cord position. Results Successful intubation occurred in 95% of patients in the fiberoptic group and in 93% of patients in the conventional group. There were no differences in number of attempts. In the fiberoptic group, 79% of patients had an intubation difficulty scale score of 0, representing an ideal intubation: that is, one performed by the first operator on the first attempt using the first technique with full glottic visualization. Only 18% of patients in the conventional group had an intubation difficulty scale score of 0 (P &lt; 0.001). More patients had Cormack grade 3 or 4 views with conventional than with fiberoptic laryngoscopy (39 vs. 2%, P &lt; 0.001). Intubation times in patients with one attempt were slightly longer in the fiberoptic (median, 25th-75th percentiles: 30, 23-53 s) compared with the conventional group (24, 17-30 s, P &lt; 0.05). Corresponding times in patients requiring &gt; one attempt were 155 (range, 112-201) s and 141 (range, 95-186) s in the fiberoptic and conventional groups, respectively (P value not significant). Conclusions Compared with conventional laryngoscopy, tracheal intubation using the fiberoptic laryngoscope was associated with lower intubation difficulty scale scores and better views of the laryngeal aperture in patients with cervical imnmobilization. However, there were no differences in success rates or number of intubation attempts.

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