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Objective The Truview Evo2TM laryngoscope blade is designed to improve glottic view. This study was designed to evaluate the effect of cricoid pressure (CP) on laryngeal view and the ease of orotracheal intubation with the Truview Evo2 laryngoscope. Methods In this randomized controlled trial, 50 patients (American Society of Anesthesiologists physical status I-II, aged 18 to 60 yr) scheduled for elective surgery were enrolled. After induction of anesthesia and muscle paralysis, laryngoscopy was performed using the Truview Evo2 TM laryngoscope with the patient's head in the neutral position. In Group 1, the percentage of glottic opening (POGO) score was evaluated first without CP, then with CP, and CP was applied for intubation. In Group 2, the POGO score was evaluated first with CP, then without CP, and no CP was applied for intubation. Time to intubation and number of attempts required for intubation were also recorded. Results In 50 patients, the mean (standard deviation) POGO view obtained with the application of CP was 93% (10%) compared with 81% (19%) in patients without CP (P \ 0.01). Times to intubation were similar in the two groups: 14.2 (6.6) sec vs 14.0 (9.3) sec in Groups 1 and 2, respectively (P = 0.924). Sixteen percent of patients in Group 1 required a second attempt at tracheal intubation, while only 4% of patients in Group 2 required a second attempt (P = 0.162). Conclusion When using the Truview Evo2TM laryngoscope with the patient's head in the neutral position, application of CP improves the glottic view. This approach is not associated with increased difficulty in intubation.

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Background and Aims:We compared the laryngoscopy position attained by a 7-cm-high pillow (Sniffing position-SP) with that attained by horizontal alignment of external auditory meatus-sternal notch (AM-S) line-using variable height inflatable pillow.Material and Methods:This prospective-randomised-cross-over study included 50 patients in each group. Group-AM-S: A 7 cm uncompressible pillow was used for attaining first laryngoscopy position, followed by horizontal alignment of external auditory meatus-sternal notch (AM-S) line-using an inflatable pillow for attaining second laryngoscopy position followed by intubation. Group-SP: Horizontal alignment of external auditory meatus-sternal notch (AM-S) line-was done using an inflatable pillow for attaining first laryngoscopy position, followed by using 7 cm uncompressible pillow for second laryngoscopy position followed by intubation. The CL-grade, Intubation Difficulty Score (IDS) and time to intubation were compared in both positions. The head raise (in cm) required for attaining AM-S alignment was noted.Results:CL-grade-I was obtained in significantly larger number of patients with AM-S alignment position than with 7 cm head raise (P = 0.004). CL-grade-III was obtained in significantly lesser number of patients with AM-S alignment (P = 0.002). Mean IDS with AM-S alignment (1.18 ± 1.69) was significantly less than with 7cm head raise (2 ± 1.59; P = 0.007) and time to intubation with AM-S alignment (17.33 ± 4.52 s) was significantly less than that with 7cm head raise (18.94 ± 4.64 s; P = 0.041). The mean head rise required to achieve AM-S line alignment was 4.920 ± 1.460 cm.Conclusion:External Auditory Meatus-Sternal notch (AM-S) line alignment provides better laryngeal view, better intubating conditions and requires lesser time to intubate as compared to a conventional 7-cm-head raise. The size of pillow used for head raise should be individualised.

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