scholarly journals A randomized study comparing the sniffing position with simple head extension for glottis visualization and difficulty in intubation during direct laryngoscopy

2017 ◽  
Vol 11 (3) ◽  
pp. 762 ◽  
Author(s):  
Zulfiqar Ali ◽  
Mehmooda Akhtar ◽  
Nelofar Hassan ◽  
Saqib Mehdi ◽  
GhMohammad Wani ◽  
...  
Keyword(s):  
Direct Laryngoscopy ◽  
Randomized Study ◽  
Head Extension

Randomized Study Comparing the “Sniffing Position” with Simple Head Extension for Laryngoscopic View in Elective Surgery Patients

2001 ◽  
Vol 95 (4) ◽  
pp. 836-841 ◽  
Author(s):  
Frédéric Adnet ◽  
Christophe Baillard ◽  
Stephen W. Borron ◽  
Christophe Denantes ◽  
Laurent Lefebvre ◽  
...  
Keyword(s):  
Direct Laryngoscopy ◽  
Elective Surgery ◽  
Randomized Study ◽  
Orotracheal Intubation ◽  
Simple Extension ◽  
Laryngoscopic View ◽  
Head Extension ◽  
Group A ◽  
Group B ◽  
Neck Mobility

Background The "sniffing position" is recommended for optimization of glottic visualization under direct laryngoscopy. However, no study to date has confirmed its superiority over simple head extension. In a prospective, randomized study, the authors compared the sniffing position with simple head extension in orotracheal intubation. Methods The study included 456 consecutive patients. The sniffing position was obtained by placement of a 7-cm cushion under the head of the patient. The extension position was obtained by simple head extension. The anesthetic procedure included two Laryngoscopies without paralysis: the first was used for topical glottic anesthesia. During the second direct laryngoscopy, intubation of the trachea was performed. The head position was randomized as follows: group A was in the sniffing position during the first Laryngoscopy and the extension position during the second, group B was in the extension position during the first laryngoscopy and the sniffing position during the second. Glottic exposure was assessed by the Cormack scale. Results The sniffing position improved glottic exposure (decreased the Cormack grade) in 18% of patients and worsened it (increased the Cormack grade) in 11% of patients, in comparison with simple extension. The Cormack grade distribution was not significantly modified between the two groups. Multivariate analysis showed that reduced neck mobility and obesity were independently related to improvement in laryngoscopic view with application of the sniffing position. Conclusions Routine use of the sniffing position appears to provide no significant advantage over simple head extension for tracheal intubation in this setting. The sniffing position appears to be advantageous in obese and head extension-limited patients.

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 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 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.

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

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