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

Bhattarai, B; Shrestha, Sharada Ram; Kandel, S

doi:10.3126/kumj.v9i1.6265

Cited by 9 publications

(18 citation statements)

References 10 publications

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“…The results of our study are supported by the studies of Singhal et al 14 , Adnet et al 15 , Bhattari et al 16 and Ambardekar et al 17 in terms of intubation difficulty score in two groups. All these studies suggest that sniffing position offers more ease of tracheal intubation than simple head extension.…”

Section: Jacksonsupporting

confidence: 90%

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Evaluation of laryngoscopic view, intubation difficulty and sympathetic response during direct laryngoscopy in sniffing position and simple head extension: a prospective and randomized comparative study

2015

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INTRODUCTIONDirect laryngoscopy is the mainstay of airway management, and despite the proliferation of difficult airway devices, alternative methods of intubation are used extremely infrequently in all settings. Proper positioning of the head and the neck is prerequisite for optimizing the laryngeal view during direct laryngoscopy. Its importance has been recognized since Kirstein 1 first described the procedure in 1895.Inadequate positioning may result in prolonged or failed tracheal intubation attempts because of the inability to visualize the larynx.There is a large discrepancy between the incidence of difficult laryngoscopy ranging from 5% of multiple attempts and 18% of poor laryngeal view to the rate of failed laryngoscopy ranging from less than 0.4% in the emergency department to 0.05% in the operating room. In most instances, difficult laryngoscopy correlates with ABSTRACT Background: Airway management is critical to the care of patients and direct laryngoscopy is the mainstay of airway management. Despite the proliferation of difficult airway devices, sniffing position for laryngoscopy remains the gold standard and ideal position. This prospective, randomized and single-blind study was done to evaluate and compare the laryngoscopic view, complexity of intubation and sympathetic response during laryngoscopy in sniffing position and simple head extension. Methods: One hundred and twenty patients, aged 20-50 years with American Society of Anesthesiologists (ASA) status 1 and 2 undergoing general anesthesia requiring orotracheal intubation were randomized into two groups. Group A used sniffing position and group B was put in simple head extension. Glottis visualization was assessed using Cormack and Lehane grade and ease of intubation was assessed on intubation difficulty scale. Laryngoscopic sympathetic response in two positions was also assessed. Results: Both the groups were comparable in demographic profiles. Glottic visualization and intubation difficulty score were better and statistically significant in sniffing position as compared to simple head extension. Although, sympathetic response was lower in sniffing position as compared to simple head extension, it was statistically insignificant. Conclusion: Sniffing position provided better glottis visualization and intubation difficulty score and increased the success rate of intubation as compared to simple head extension.

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Section: Jacksonsupporting

confidence: 90%

“…Bhattarai et al 16 in 2011 compared sniffing position with simple head extension for visualization of glottis during direct laryngoscopy in 400 patients. They found that glottis visualization is clinically better in sniffing position but not statistically significant (P value >0.05).…”

Section: Jacksonmentioning

confidence: 99%

Evaluation of laryngoscopic view, intubation difficulty and sympathetic response during direct laryngoscopy in sniffing position and simple head extension: a prospective and randomized comparative study

2015

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“…After assessing the full text of these potentially useful studies, we included 6 studies with 2759 participants ( Fig. 1) [8,[13][14][15]23,24]. All 6 trials were prospective, randomized, and controlled, and provided data on glottic visualization and one or more data associated with intubation performance.…”

Section: Study Descriptionmentioning

confidence: 99%

“…All 6 trials were prospective, randomized, and controlled, and provided data on glottic visualization and one or more data associated with intubation performance. Each of 3 studies compared the success rate of intubation [14,15,24], the intubation time [15,23,24], and IDS score [8,13,15]. Four studies compared intubation in the SP to that in the simple head extension position, and 2 studies compared intubation in the SP to the so-called "ramp" position [23,24] (Table 1).…”

Section: Study Descriptionmentioning

confidence: 99%

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Effects of sniffing position for tracheal intubation: a meta-analysis of randomized controlled trials

Akihisa

Hoshijima

Maruyama

et al. 2015

The American Journal of Emergency Medicine

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A comparative evaluation of the sniffing, the simple head extension and the head hyperextension positions for laryngoscopic view and intubation difficulty in adults undergoing direct laryngoscopy

Hadhoud,

Baraka,

Saleh

et al. 2023

Eur Arch Otorhinolaryngol

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Objective This work aimed to compare between the laryngoscopy positions; sniffing, simple head extension and head hyperextension positions to assess whether the laryngeal view, intubation time and intubation difficulty could improve with one of these positions than the others. Design Prospective randomized three arms clinical trial. Setting Operation room, the phoniatrics unit [removed for blind peer review]. Participants The study included 75 cases with 25 cases in each group. Group "A" with head in the sniffing position, Group "B" with the head in simple extension position, Group "C" with head in hyperextension position. Results The three groups were compared regarding intubation time and laryngoscopic view time. Intubation time showed statistically significant difference between the three groups. Mean of sniffing group (No. = 25) was 13.19 s (± 3.35). Mean of simple extension group (No. = 25) was 11.29 s (± 3.14). Mean of Hyperextension group (No. = 25) was 14.39 s (± 4.14). Laryngoscopic view time showed statistically highly significant difference between the three groups. Mean of sniffing group (No. = 25) was 17.19 s (± 7.27). Mean of simple group (No. = 25) was 12.18 s (± 4.46). Mean of hyperextension group (No. = 25) was 17.08 s (± 6.51). Conclusion Comparing the sniffing, the simple extension and the hyperextension positions, the simple extension position showed the best time regarding intubation time and laryngoscopic view time.

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

Cited by 9 publications

References 10 publications

Evaluation of laryngoscopic view, intubation difficulty and sympathetic response during direct laryngoscopy in sniffing position and simple head extension: a prospective and randomized comparative study

Evaluation of laryngoscopic view, intubation difficulty and sympathetic response during direct laryngoscopy in sniffing position and simple head extension: a prospective and randomized comparative study

Effects of sniffing position for tracheal intubation: a meta-analysis of randomized controlled trials

A comparative evaluation of the sniffing, the simple head extension and the head hyperextension positions for laryngoscopic view and intubation difficulty in adults undergoing direct laryngoscopy

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