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

Adnet, Frédéric; Baillard, Christophe; Borron, Stephen W.; Denantes, C.; Lefèbvre, Laurent; Galinski, Michel; Martinez, Carmen; Cupa, M; Lapostolle, Frédéric

doi:10.1097/00000542-200110000-00009

Cited by 200 publications

(110 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast to our study, Adnet et al 6 demonstrated no differences in the laryngoscopic views and intubation difficulty scale comparisons between simple head extension and sniffing positions in 456 patients. Several anatomic factors contribute to visualization of the glottis during laryngoscopy, of which OAA extension is only one addition; a difference in the OAA extension angle between simple head extension and sniffing positions was only 3.8°.…”

Section: Discussioncontrasting

confidence: 99%

“…They subsequently demonstrated that the sniffing position provides no advantage for improving the laryngoscopic view compared to simple head extension. 6 Direct laryngoscopy requires movement of the cervical spine for optimal visualization of the glottis. Among the cervical spine segments, extension at the occipito-atlanto-axial (OAA) complex is pivotal for several reasons.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The sniffing position provides greater occipitoatlanto-axial angulation than simple head extension: A radiological study

Takenaka

Aoyama

Iwagaki

et al. 2007

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: While the anatomic sniffing position has traditionally been considered the standard head and neck position for laryngoscopy, recent evidence suggests that the sniffing position provides no significant advantage over simple head extension. To establish if the sniffing position provides an anatomic advantage, we compared the occipito-atlanto-axial extension angle, a key determinant for obtaining a good laryngeal view during laryngoscopy, in simple head extension and sniffing positions.Methods: Thirty volunteers with normal cervical spines were studied. Radiological examinations of the lateral cervical spine were taken and compared in each of the following three positions for each subject: neutral position (flat on the table with no pillow and without head extension or flexion); simple head extension (head maximally extended without a pillow); and the sniffing position (head extension with cervical flexion obtained by 7 cm occipital elevation).Results: Mean angles of the occipito-atlanto-axial extension in simple head extension and the sniffing position were 20.4°± 5.1°and 24.2°± 5.6°, respectively (P < 0.01). Conclusion:The anatomic sniffing position provides greater occipito-atlanto-axial extension compared to simple head extension. These findings should be taken into consideration when optimizing patient positioning for laryngoscopy. de 20,4° ± 5,1° et 24,2° ± 5,6° respectivement (P < 0,01

show abstract

Section: Discussioncontrasting

confidence: 99%

mentioning

confidence: 99%

The sniffing position provides greater occipitoatlanto-axial angulation than simple head extension: A radiological study

Takenaka

Aoyama

Iwagaki

et al. 2007

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…The results of our study were also contrary to the study done by Adnet et al 15 in 2001, where they compared the "sniffing position" with simple head extension for laryngoscopic view in elective surgery. They found no significant advantage of the sniffing position over simple head extension in terms of laryngoscopic view (with the exception of obese patients and those with limited extension).…”

Section: Jacksoncontrasting

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

View full text Add to dashboard Cite

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.

show abstract

“…For direct laryngoscopy, alignment of the oral, pharyngeal, and laryngeal axes is necessary to view the glottis, but line-of-sight visualization may be impossible for some patients secondary to anatomic factors. [4] Devices allowing the clinician to overcome these obstacles are of critical importance in airway emergencies. Studies reported improved laryngeal view with airway devices allowing for indirect visualization of the glottis in difficult airway models.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Airtraq optical laryngoscope and Storz video laryngoscope in a cadaver model

Wadman¹,

Dierks²,

Branecki³

et al. 2011

World Journal of Emergency Medicine

View full text Add to dashboard Cite

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

Abstract: 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.

Cited by 200 publications

References 14 publications

The sniffing position provides greater occipitoatlanto-axial angulation than simple head extension: A radiological study

The sniffing position provides greater occipitoatlanto-axial angulation than simple head extension: A radiological 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

Comparison of Airtraq optical laryngoscope and Storz video laryngoscope in a cadaver model

Contact Info

Product

Resources

About