Comparison of the Glottic Views in a Head Elevated Laryngoscopy Position with the Patient in Supine or 25º Backup: An Observer-Blinded Randomised Clinical Trial

Nandhakumar, Janani; Reddy, Hemanth Kumar Vadlamudi; Maurya, Indubala; Nag, Kusha

doi:10.5152/tjar.2021.1058

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…The same results were obtained in another study that was done by B. J. Lee et al [8]. In agreement, Nandhakumar et al revealed that the 25° backup position was significantly associated with between glottic view and less difficult intubation [9].…”

Section: Discussionsupporting

confidence: 82%

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Comparative study of the difficulty of endotracheal intubation in sniffing and 25-degree backup positions

Ibrahem

2024

Vestn. anesteziol. reanimatol.

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Introduction. The endotracheal intubation procedure is integral to modern medicine and essential to emergency care, surgical practice and intensive care procedures.The objective was to evaluate the effect of the 25° backup position on glottic view and difficulty of intubation compared to the sniffing position in adult patients receiving general anaesthesia with endotracheal intubationMaterials and methods. The comparative clinical study was conducted in Al-Hussain Military Hospital, Baghdad, Iraq during the period from 1st of January 2022 to 1st of January 2023. A convenient sample of 150 patients who aged 18–60 years, were classified according to the American Society of Anesthesiologists as I or II, and underwent elective surgery under general anaesthesia was included in this study. These patients were allocated into two groups. Group A consisted of 75 patients who were anaesthetized in the sniffing position. Group B consisted of 75 patients who were anaesthetized in 25° backup position.Results. There was no significant difference between the sniffing position and 25° backup position regarding the number of patients who needed ancillary manoeuvres and ancillary equipment (P-values were 0.583 and 0.151, respectively). The glottic view was significantly better in the 25° backup position than the sniffing position according to the Cormack–Lehane (p = 0.001) with a significantly lower difficulty in intubation according to the intubation difficulty scale (p = 0.008).Conclusion. The 25° backup position is better than the sniffing position in glottic visualization, the difficulty of intubation and the time of intubation. Age, gender, and body mass index have no significant effects on the visualization of the glottis between the 25° backup position and the sniffing position. There was no significant difference between two regarding the number of patients who needed ancillary manoeuvres and ancillary equipment. The glottic view is significantly better in the 25° backup position than sniffing position according to the Cormack–Lehane. The mean of the time of intubation is lower in the 25° backup position compared to the sniffing position.

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Section: Discussionsupporting

confidence: 82%

“…results were obtained in another study that was done by J. Nandhakumar et al [9]. These results agreed with another study that was done by R.M.…”

Section: Time Of Intubationsupporting

confidence: 90%

Comparative study of the difficulty of endotracheal intubation in sniffing and 25-degree backup positions

Ibrahem

2024

Vestn. anesteziol. reanimatol.

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“…The results were consistent with the study findings of other authors. [ 10 ] It was found that the HELP position was superior when compared to supine in improving the CL grade. This can be explained by the HELP position aligning the sternal notch and external auditory meatus in a horizontal line, which in turn aligns the three axes of the airway, namely, the pharyngeal, laryngeal and oral axes.…”

Section: Discussionmentioning

confidence: 99%

Comparing the posture and comfort of anaesthesiologists during laryngoscopy and tracheal intubation in the head-elevated laryngoscopy position in supine position and with a 25° backup: A randomised clinical crossover trial

Mookambika,

Hemanth Kumar,

Areti

et al. 2024

Indian Journal of Anaesthesia

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Background and Aims: The head-elevated laryngoscopy position (HELP) and a 25° backup have been proposed to enhance glottic visualisation, yet concerns about ergonomic discomfort hinder their widespread adoption. This study compares the comfort and posture adopted by anaesthesiologists while performing laryngoscopy and tracheal intubation with patients in HELP while in a supine position or with 25° backup. Methods: The study included 48 patients aged 18–60 years with normal airways and 12 experienced anaesthesiologists. Patients were randomised into two groups using permuted block randomisation. Anaesthesiologists performed laryngoscopy and intubation in supine HELP and 25° backup HELP positions. Anaesthesiologist’s posture was determined by measuring the angles of neck, wrist, elbow, back and knee joints, which were compared using Student’s t-test, and subjective comfort assessed on a Likert scale was compared using the Chi-square test. As mentioned by the anaesthesiologist, Cormack- Lehane grading was also noted and compared using a Chi-square test between groups, taking a P value <0.05 as significant. Results: Both positions demonstrated comparable anaesthesiologist posture (P = 0.919) and comfort (P = 0.644). However, the 25° backup HELP positions significantly improved Cormack–Lehane grades, with 68% achieving grade 1 compared to 31% in the supine HELP group (P = 0.012). Haemodynamic stability and tracheal intubation time showed no significant differences between the groups (P = 0.475 and 0.117, respectively), and no complications were reported in either group. Conclusion: Anaesthesiologists’ posture and comfort during laryngoscopy and tracheal intubation are similar between supine and 25° backup in patients with easy airways.

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The effectiveness of prehospital rapid sequence intubation in critically ill patients

Alanazi,

Alotaibi,

Alanazi

et al. 2024

Int. J. of Health Sci.

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Background Tracheal intubation in critically sick patients presents a significant risk of complications attributable to variables such as respiratory failure, hemodynamic instability, and drug sensitivity. Present recommendations mostly depend on expert opinion and data from elective intubations, lacking substantial evidence from randomized controlled trials (RCTs) in critical care environments (ICU, ED, general wards). This systematic review sought to assess high-quality evidence-based methods for intubation in critically sick patients, concentrating on pharmacological agents, techniques, and equipment. Methods A thorough search of PubMed, BioMed Central, Embase, and the Cochrane Central Register of Clinical Trials found pertinent randomized controlled trials examining treatments aimed at enhancing the success rate and safety of tracheal intubation in critically sick patients. A meta-analysis was conducted when applicable. Results Intubation problems in critically sick patients vary from 4.2% to 39%. Pre-oxygenation by non-invasive ventilation (NIV) has shown enhanced effectiveness over conventional techniques in extending safe apnea duration and minimizing desaturation. Although high-flow nasal cannula (HFNC) enhanced comfort, its advantages for apneic oxygenation were restricted in this demographic. Etomidate and ketamine had equivalent safety and effectiveness as sedatives, whilst succinylcholine and rocuronium showed similar success rates as neuromuscular blocking drugs. The sniffing position outperformed the ramping position for laryngoscopy.

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Comparison of the Glottic Views in a Head Elevated Laryngoscopy Position with the Patient in Supine or 25º Backup: An Observer-Blinded Randomised Clinical Trial

Cited by 3 publications

References 21 publications

Comparative study of the difficulty of endotracheal intubation in sniffing and 25-degree backup positions

Comparative study of the difficulty of endotracheal intubation in sniffing and 25-degree backup positions

Comparing the posture and comfort of anaesthesiologists during laryngoscopy and tracheal intubation in the head-elevated laryngoscopy position in supine position and with a 25° backup: A randomised clinical crossover trial

The effectiveness of prehospital rapid sequence intubation in critically ill patients

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